Post on 27-Aug-2020
RESPIRATORY HEALTH ASSOCIATION1440 WEST WASHINGTON BOULEVARDCHICAGO, IL 60607ATTENTION: JOHN BECKER
DEAR JOHN,
ENCLOSED ARE THE ORIGINAL AND ONE COPY OF THE 2012 EXEMPTORGANIZATION RETURNS, AS FOLLOWS...
2012 FORM 990
2012 ILLINOIS FORM AG990-IL
EACH ORIGINAL SHOULD BE DATED, SIGNED AND FILED IN ACCORDANCEWITH THE FILING INSTRUCTIONS. THE COPY SHOULD BE RETAINEDFOR YOUR FILES.
WE SINCERELY APPRECIATE THE OPPORTUNITY TO SERVE YOU. PLEASECONTACT US IF YOU HAVE ANY QUESTIONS CONCERNING THE TAXRETURN.
WE HAVE PREPARED THE RETURN FROM INFORMATION YOU FURNISHED USWITHOUT VERIFICATION. UPON EXAMINATION OF THE RETURN BY TAXAUTHORITIES, REQUESTS MAY BE MADE FOR UNDERLYING DATA. WETHEREFORE RECOMMEND THAT YOU PRESERVE ALL RECORDS WHICH YOUMAY BE CALLED UPON TO PRODUCE IN CONNECTION WITH SUCHPOSSIBLE EXAMINATIONS.
VERY TRULY YOURS,
WAYNE HARDERDIRECTOR
20094105-01-12
~~~~~~~~~~~~~~~~~
FOR THE YEAR ENDING
Prepared for
Prepared by
Amount dueor refund
Make checkpayable to
Mail tax returnand check (ifapplicable) to
Return must bemailed onor before
SpecialInstructions
TAX RETURN FILING INSTRUCTIONS
FORM 990
JUNE 30, 2013
RESPIRATORY HEALTH ASSOCIATION1440 WEST WASHINGTON BOULEVARDCHICAGO, IL 60607
MCGLADREY LLP1 S. WACKER DRIVE, STE 800CHICAGO, IL 60606
NOT APPLICABLE
NOT APPLICABLE
DEPARTMENT OF THE TREASURYINTERNAL REVENUE SERVICE CENTEROGDEN, UT 84201-0027
MAY 15, 2014
THE RETURN SHOULD BE SIGNED AND DATED.
TO DOCUMENT THE TIMELY FILING OF YOUR TAX RETURN, WE SUGGESTTHAT YOU OBTAIN AND RETAIN PROOF OF MAILING. PROOF OF MAILINGCAN BE ACCOMPLISHED BY SENDING THE TAX RETURN BY REGISTERED ORCERTIFIED MAIL (METERED BY THE U.S. POSTAL SERVICE) OR THROUGHTHE USE OF AN IRS APPROVED DELIVERY METHOD PROVIDED BY AN IRSDESIGNATED PRIVATE DELIVERY SERVICE.
Checkifself-employed
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Check ifapplicable:
AddresschangeNamechangeInitialreturn
Termin-atedAmendedreturn Gross receipts $
Applica-tionpending
232001 12-10-12
Beginning of Current Year
Paid
Preparer
Use Only
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lungbenefit trust or private foundation)
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning and ending
B C D Employer identification number
E
G
H(a)
H(b)
H(c)
F Yes No
Yes No
I
J
K
Website: |
L M
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Prior Year Current Year
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Re
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Sign
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Yes No
For Paperwork Reduction Act Notice, see the separate instructions.
|
(or P.O. box if mail is not delivered to street address) Room/suite
Are all affiliates included?
)501(c)(3) 501(c) ( (insert no.) 4947(a)(1) or 527
|Corporation Trust Association OtherForm of organization: Year of formation: State of legal domicile:
|
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Net
Ass
ets
orFu
nd B
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ces
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Signature of officer Date
Type or print name and title
Date PTINPrint/Type preparer's name Preparer's signature
Firm's name Firm's EIN
Firm's address
Phone no.
Form
The organization may have to use a copy of this return to satisfy state reporting requirements.
Name of organization
Doing Business As
Number and street Telephone number
City, town, or post office, state, and ZIP code
Is this a group return
for affiliates?Name and address of principal officer:
If "No," attach a list. (see instructions)
Group exemption number |
Tax-exempt status:
Briefly describe the organization's mission or most significant activities:
Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2012 (Part V, line 2a)
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, line 34
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
����������������������
Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~
Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) ���
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
~~~~~~~~~~~
~~~~~~~~~~~~~
~~~
Professional fundraising fees (Part IX, column (A), line 11e)
Total fundraising expenses (Part IX, column (D), line 25)
~~~~~~~~~~~~~~
Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)
Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 18 from line 12
~~~~~~~~~~~~~
~~~~~~~
����������������
Total assets (Part X, line 16)
Total liabilities (Part X, line 26)
Net assets or fund balances. Subtract line 21 from line 20
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~
��������������
May the IRS discuss this return with the preparer shown above? (see instructions) ���������������������
LHA Form (2012)
Part I Summary
Signature BlockPart II
990
Return of Organization Exempt From Income Tax990 2012
§
==
999
JUL 1, 2012 JUN 30, 2013
Respiratory Health AssociationX 36-2222687
1440 West Washington Boulevard (312)243-20005,477,474.
Chicago, IL 60607Joel J. Africk X
same as C aboveX
www.lungchicago.orgX 1906 IL
To promote healthy lungs andfight lung disease through research, advocacy, and education.
323258
5000.0.
7,785,363. 2,845,470.922,742. 357,751.55,645. 135,563.
100,306. -101,109.8,864,056. 3,237,675.1,991,900. 85,655.
0. 0.3,035,420. 2,397,641.
0. 0.532,226.
3,703,838. 806,372.8,731,158. 3,289,668.132,898. -51,993.
4,495,140. 4,239,322.1,933,162. 1,493,533.2,561,978. 2,745,789.
Joel J. Africk, President & CEO
Wayne Harder P00294296MCGLADREY LLP 42-07143251 S. WACKER DRIVE, STE 800CHICAGO, IL 60606 312-634-3400
X
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Expenses $ including grants of $ Revenue $
23200212-10-12
1
2
3
4
Yes No
Yes No
4a
4b
4c
4d
4e Total program service expenses
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part III �����������������������������
Briefly describe the organization's mission:
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
If "Yes," describe these new services on Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
If "Yes," describe these changes on Schedule O.
~~~~~~
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
( ) ( ) ( )
( ) ( ) ( )
( ) ( ) ( )
Other program services (Describe in Schedule O.)
( ) ( )
Form (2012)
2Statement of Program Service AccomplishmentsPart III
990
J
Respiratory Health Association 36-2222687
X
To promote healthy lungs and fight lung disease through research,advocacy, and education.
X
X
1,511,521. 47,901. 216,510.Lung Health Programs: Reduce the burden of chronic disease (especiallyasthma, lung cancer, and COPD) throughout the community.
We use health educators and other trained staff/volunteers to educatecommunities about how they can address lung health disparities andeducate individuals about how to manage their lung disease. Currently,our programs and projects include: Fight Asthma Now (for youth/teens),Asthma Management (for caregivers), Asthma-Friendly Childcare Project,Addressing Asthma in Northern Lake County Project, COPD Initiativeincluding our Living Better Together COPD Conference, Healthy LungsInitiative, Radon Awareness efforts, etc.
700,174. 137,170.Tobacco Control: Reduce smoking rate, reduce exposure to secondhandsmoke and prevent youth from using tobacco.
Respiratory Health Association is collaborating with Chicago PublicSchools on a grant from the Centers for Disease Control and Preventionaimed at decreasing the smoking rate and exposure to secondhand smokeamong Chicago Public Schools students.
In addition, the Healthy Lungs Initiative, in collaboration with theCook County Health and Hospitals System, provides direct counseling andother resources to smokers who want to quit.
248,296. 7,754. 11,220.Environmental Health: Promote policies that improve indoor and outdoorair quality and raise awareness about how air pollution affects lunghealth.
In 2013 we supported educational/awareness activities to limit idlingby diesel vehicles and equipment and urged local and state governmentto adopt public contract requirements that require the use of cleanerdiesel construction equipment. We also worked to limit pollution bycoal-fired power plants throughout Illinois. We called for action toreduce air pollution from transit vehicles, including diesel buses andlocomotives, and initiated community-based awareness activities toinform local residents about risks to their lung health. Federal
64,043. 30,000. 3,388.2,524,034.
See Schedule O for Continuation(s) 2
23200312-10-12
Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1
2
3
4
5
6
7
8
9
10
Section 501(c)(3) organizations.
a
b
c
d
e
f
a
b
11a
11b
11c
11d
11e
11f
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
a
b
a
b
If "Yes," complete Schedule ASchedule B, Schedule of Contributors
If "Yes," complete Schedule C, Part I
If "Yes," complete Schedule C, Part II
If "Yes," complete Schedule C, Part III
If "Yes," complete Schedule D, Part I
If "Yes," complete Schedule D, Part IIIf "Yes," complete
Schedule D, Part III
If "Yes," complete Schedule D, Part IV
If "Yes," complete Schedule D, Part V
If "Yes," complete Schedule D,Part VI
If "Yes," complete Schedule D, Part VII
If "Yes," complete Schedule D, Part VIII
If "Yes," complete Schedule D, Part IXIf "Yes," complete Schedule D, Part X
If "Yes," complete Schedule D, Part XIf "Yes," complete
Schedule D, Parts XI and XII
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optionalIf "Yes," complete Schedule E
If "Yes," complete Schedule F, Parts I and IV
If "Yes," complete Schedule F, Parts II and IV
If "Yes," complete Schedule F, Parts III and IV
If "Yes," complete Schedule G, Part I
If "Yes," complete Schedule G, Part IIIf "Yes,"
complete Schedule G, Part IIIIf "Yes," complete Schedule H
Form 990 (2012) Page
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete ?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year?
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts?
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent
endowments, or quasi-endowments?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~
If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X
as applicable.
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total
assets reported in Part X, line 16?
Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total
assets reported in Part X, line 16?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in
Part X, line 16?
Did the organization report an amount for other liabilities in Part X, line 25?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?
Did the organization obtain separate, independent audited financial statements for the tax year?
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization included in consolidated, independent audited financial statements for the tax year?
~~~~~
Is the organization a school described in section 170(b)(1)(A)(ii)?
Did the organization maintain an office, employees, or agents outside of the United States?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization
or entity located outside the United States?
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals
located outside the United States?
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
Did the organization operate one or more hospital facilities?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ����������
Form (2012)
3Part IV Checklist of Required Schedules
990
Respiratory Health Association 36-2222687
XX
X
X
X
X
X
X
X
X
X
X
X
XX
X
X
XXX
X
X
X
X
X
XX
3
23200412-10-12
Yes No
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
21
22
23
24a
24b
24c
24d
25a
25b
26
27
28a
28b
28c
29
30
31
32
33
34
35a
35b
36
37
38
a
b
c
d
a
b
Section 501(c)(3) and 501(c)(4) organizations.
a
b
c
a
b
Section 501(c)(3) organizations.
Note.
(continued)
If "Yes," complete Schedule I, Parts I and II
If "Yes," complete Schedule I, Parts I and III
If "Yes," completeSchedule J
If "Yes," answer lines 24b through 24d and completeSchedule K. If "No", go to line 25
If "Yes," complete Schedule L, Part I
If "Yes," completeSchedule L, Part I
If "Yes," complete Schedule L, Part II
If "Yes," complete Schedule L, Part III
If "Yes," complete Schedule L, Part IVIf "Yes," complete Schedule L, Part IV
If "Yes," complete Schedule L, Part IVIf "Yes," complete Schedule M
If "Yes," complete Schedule M
If "Yes," complete Schedule N, Part IIf "Yes," complete
Schedule N, Part II
If "Yes," complete Schedule R, Part IIf "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part VI
Form 990 (2012) Page
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the
United States on Part IX, column (A), line 1? ~~~~~~~~~~~~~~~~~~
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX,
column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
Did the organization engage in an excess benefit transaction with a
disqualified person during the year?
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified
person outstanding as of the end of the organization's tax year?
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
of any of these persons?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, or key employee? ~~~~~~~~~~~
A family member of a current or former officer, director, trustee, or key employee?
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner?
~~
~~~~~~~~~~~~~~~~~~~~~
Did the organization receive more than $25,000 in non-cash contributions?
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions?
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization liquidate, terminate, or dissolve and cease operations?
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3?
Was the organization related to any tax-exempt or taxable entity?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)?
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Did the organization make any transfers to an exempt non-charitable related organization?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? ~~~~~~~~
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?
All Form 990 filers are required to complete Schedule O �������������������������������
Form (2012)
4Part IV Checklist of Required Schedules
990
Respiratory Health Association 36-2222687
X
X
X
X
X
X
X
X
XX
XX
X
X
X
X
XX
X
X
X
4
23200512-10-12
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations.
Yes No
1
2
3
4
5
6
7
a
b
c
1a
1b
1c
a
b
2a
Note.
2b
3a
3b
4a
5a
5b
5c
6a
6b
7a
7b
7c
7e
7f
7g
7h
8
9a
9b
a
b
a
b
a
b
c
a
b
Organizations that may receive deductible contributions under section 170(c).
a
b
c
d
e
f
g
h
7d
8
9
10
11
12
13
14
Sponsoring organizations maintaining donor advised funds.
a
b
Section 501(c)(7) organizations.
a
b
10a
10b
Section 501(c)(12) organizations.
a
b
11a
11b
a
b
Section 4947(a)(1) non-exempt charitable trusts. 12a
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Note.
a
b
c
a
b
13a
13b
13c
14a
14b
e-file
If "No," provide an explanation in Schedule O
If "No," provide an explanation in Schedule O
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
Did the supporting
organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?
Form (2012)
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part V �����������������������������
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners? �������������������������������������������
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions)
~~~~~~~~~~
Did the organization have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a Form 990-T for this year?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
~~~~~~~~~~~~
~~~~~~~~~
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions?
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization notify the donor of the value of the goods or services provided?
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
~~~~~~~~~~~~~~~
����������������������������������������������������
If "Yes," indicate the number of Forms 8282 filed during the year
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
~~~~~~~~~~~~~~~~
~~~~~~~
~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
~
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
~~~~~~~~~~~~~~~
~~~~~~
Enter:
Gross income from members or shareholders
Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year ������
Is the organization licensed to issue qualified health plans in more than one state?
See the instructions for additional information the organization must report on Schedule O.
~~~~~~~~~~~~~~~~~~~~~
Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans
Enter the amount of reserves on hand
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive any payments for indoor tanning services during the tax year?
If "Yes," has it filed a Form 720 to report these payments?
~~~~~~~~~~~~~~~~
����������
5Part V Statements Regarding Other IRS Filings and Tax Compliance
990
J
Respiratory Health Association 36-2222687
140
X
58X
X
X
XX
X
XX
X
XX
X
5
23200612-10-12
Yes No
1a
1b
1
2
3
4
5
6
7
8
9
a
b
2
3
4
5
6
7a
7b
8a
8b
9
a
b
a
b
Yes No
10
11
a
b
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
a
b
12a
b
c
13
14
15
a
b
16a
b
17
18
19
20
For each "Yes" response to lines 2 through 7b below, and for a "No" responseto line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
If "Yes," provide the names and addresses in Schedule O(This Section B requests information about policies not required by the Internal Revenue Code.)
If "No," go to line 13
If "Yes," describein Schedule O how this was done
(explain in Schedule O)
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
Form (2012)
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VI �����������������������������
Enter the number of voting members of the governing body at the end of the tax year
Enter the number of voting members included in line 1a, above, who are independent
~~~~~~
~~~~~~
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
Did the organization have members or stockholders?
~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body?
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The governing body?
Each committee with authority to act on behalf of the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address? �����������������
Did the organization have local chapters, branches, or affiliates?
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
Describe in Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization regularly and consistently monitor and enforce compliance with the policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements? ������������������������������������
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
Own website Another's website Upon request Other
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: |
6Part VI Governance, Management, and Disclosure
Section A. Governing Body and Management
Section B. Policies
Section C. Disclosure
990
J
Respiratory Health Association 36-2222687
X
32
32
X
XXXX
X
X
XX
X
X
X
XX
XXX
XX
X
IL
X
Joel J. Africk - (312)243-20001440 West Washington Boulevard, Chicago, IL 60607
6
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Key
empl
oyee
Hig
hest
com
pens
ated
empl
oyee
Form
er
(do not check more than onebox, unless person is both anofficer and a director/trustee)
232007 12-10-12
current
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
current
current
former
former directors or trustees
(A) (B) (C) (D) (E) (F)
Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received reportablecompensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VII�����������������������������
¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.Enter -0- in columns (D), (E), and (F) if no compensation was paid.
¥ List all of the organization's key employees, if any. See instructions for definition of "key employee."¥
.
¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.
¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization,more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
PositionName and Title Average hours per
week (list any
hours forrelated
organizationsbelowline)
Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
Form (2012)
7Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
990
Respiratory Health Association 36-2222687
(1) Bradley D. Murlick 0.30Chair X X 0. 0. 0.(2) Cynthia Gronkiewicz, RN, MS, AP 0.30Chair-Elect X X 0. 0. 0.(3) David B. Yelin, Esq. 0.30Vice Chair X X 0. 0. 0.(4) H. Ari Jaffe, MD 0.30Secretary X X 0. 0. 0.(5) Steven L. Victor 0.30Treasurer X X 0. 0. 0.(6) Barry Levenstam, Esq. 0.30Past Board Chair X X 0. 0. 0.(7) Bapu P. Arekapudi, M.D. 0.30Board Member X 0. 0. 0.(8) Darryl M. Bradford 0.30Board Member X 0. 0. 0.(9) Joan D. Boomsma, M.D., MBA 0.30Board Member X 0. 0. 0.(10) Andrew Carolus 0.30Board Member X 0. 0. 0.(11) Cathy Catrambone, Ph.D., R.N. 0.30Board Member X 0. 0. 0.(12) Manuel P.A. Claudio, M.D. 0.30Board Member X 0. 0. 0.(13) Robert Cohen, M.D. 0.30Board Member X 0. 0. 0.(14) John M. Coruthers 0.30Board Member X 0. 0. 0.(15) Paul F. Detjen, M.D. 0.30Board Member X 0. 0. 0.(16) Donna Frownfelter, P.T., M.A. 0.30Board Member X 0. 0. 0.(17) Willard A. Fry, M.D. 0.30Board Member X 0. 0. 0.
7
Form
er
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Hig
hest
com
pens
ated
empl
oyee
Key
empl
oyee
(do not check more than onebox, unless person is both anofficer and a director/trustee)
23200812-10-12
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B) (C)(A) (D) (E) (F)
1b
c
d
Sub-total
Total from continuation sheets to Part VII, Section A
Total (add lines 1b and 1c)
2
Yes No
3
4
5
former
3
4
5
Section B. Independent Contractors
1
(A) (B) (C)
2
(continued)
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such person
Page Form 990 (2012)
PositionAverage hours per
week(list any
hours forrelated
organizationsbelowline)
Name and title Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
~~~~~~~~ |
���������������������� |
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization |
Did the organization list any officer, director, or trustee, key employee, or highest compensated employee on
line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? ~~~~~~~~~~~~~
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? ������������������������
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
Name and business address Description of services Compensation
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization |
Form (2012)
8Part VII
990
Respiratory Health Association 36-2222687
(18) Douglas A. Graham, Esq. 0.30Board Member X 0. 0. 0.(19) Cynthia Gronkiewicz, RN, MS 0.30Board Member X 0. 0. 0.(20) Diana P. Hackbarth, Ph.D., R.N. 0.30Board Member X 0. 0. 0.(21) Thomas A. Hensing, M.D. 0.30Board Member X 0. 0. 0.(22) Eva Hernandez, M.S.N. 0.30Board Member X 0. 0. 0.(23) Ravi Kalhan, M.D., M.S. 0.30Board Member X 0. 0. 0.(24) Jennifer Levin 0.30Board Member X 0. 0. 0.(25) Anthony M. Marinelli, M.D. 0.30Board Member X 0. 0. 0.(26) Paul Mastrapa 0.30Board Member X 0. 0. 0.
0. 0. 0.259,256. 0. 12,783.259,256. 0. 12,783.
1
X
X
X
NONE
0See Part VII, Section A Continuation sheets
8
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Key
empl
oyee
Hig
hest
com
pens
ated
em
ploy
ee
Form
er
23220107-25-12
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(A) (B) (C) (D) (E) (F)
(continued)Form 990
Name and title Average hours
per week
(list anyhours forrelated
organizationsbelowline)
Position (check all that apply)
Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
Total to Part VII, Section A, line 1c �������������������������
Part VII
Respiratory Health Association 36-2222687
(27) Jamar McNeil 0.30Board Member X 0. 0. 0.(28) Christopher O'Hara 0.30Board Member X 0. 0. 0.(29) Thomas Pluss 0.30Board Member X 0. 0. 0.(30) Laura Rogers, M.D. 0.30Board Member X 0. 0. 0.(31) William B. Van de Graaff, M.D 0.30Board Member X 0. 0. 0.(32) Janet Williams 0.30Board Member X 0. 0. 0.(33) Joel J. Africk 40.00President & CEO X 259,256. 0. 12,783.
259,256. 12,783.
9
Noncash contributions included in lines 1a-1f: $
23200912-10-12
Total revenue.
(A) (B) (C) (D)
1 a
b
c
d
e
f
g
h
1
1
1
1
1
1
a
b
c
d
e
f
Co
ntr
ibu
tio
ns
, G
ifts
, G
ran
tsa
nd
Oth
er
Sim
ila
r A
mo
un
ts
Total.
a
b
c
d
e
f
g
2
Pro
gra
m S
erv
ice
Re
ven
ue
Total.
3
4
5
6 a
b
c
d
a
b
c
d
7
a
b
c
8
a
b
9 a
b
c
a
b
10 a
b
c
a
b
11 a
b
c
d
e Total.
Oth
er
Re
ven
ue
12
Revenue excludedfrom tax undersections 512,513, or 514
All other contributions, gifts, grants, and
similar amounts not included above
See instructions.
Form (2012)
Page Form 990 (2012)
Check if Schedule O contains a response to any question in this Part VIII ���������������������������
Total revenue Related orexempt function
revenue
Unrelatedbusinessrevenue
Federated campaigns
Membership dues
~~~~~~
~~~~~~~~
Fundraising events
Related organizations
~~~~~~~~
~~~~~~
Government grants (contributions)
~~
Add lines 1a-1f ����������������� |
Business Code
All other program service revenue ~~~~~
Add lines 2a-2f ����������������� |
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
~~~~~~~~~~~~~~~~~ |
|
Royalties ����������������������� |
(i) Real (ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)
~~~~~~~
~~~
~~
�������������� |
Gross amount from sales of
assets other than inventory
(i) Securities (ii) Other
Less: cost or other basis
and sales expenses
Gain or (loss)
~~~
~~~~~~~
Net gain or (loss) ������������������� |
Gross income from fundraising events (not
including $ of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~~
Less: direct expenses~~~~~~~~~~
Net income or (loss) from fundraising events ����� |
Gross income from gaming activities. See
Part IV, line 19 ~~~~~~~~~~~~~
Less: direct expenses
Net income or (loss) from gaming activities
~~~~~~~~~
������ |
Gross sales of inventory, less returns
and allowances ~~~~~~~~~~~~~
Less: cost of goods sold
Net income or (loss) from sales of inventory
~~~~~~~~
������ |
Miscellaneous Revenue Business Code
All other revenue ~~~~~~~~~~~~~
Add lines 11a-11d ~~~~~~~~~~~~~~~ |
|�������������
9Part VIII Statement of Revenue
990
Respiratory Health Association 36-2222687
1,475,991.
899,268.
470,211.
2,845,470.
Lung Health 900099 210,315. 210,315.Tobacco Control 900099 133,246. 133,246.Environmental Health 900099 10,899. 10,899.Research 900099 3,291. 3,291.
357,751.
43,279. 43,279.
213,357.116,383.96,974.
96,974. 96,974.
1,713,109.
1,620,825.92,284.
92,284. 92,284.
1,475,991.
293,971.502,591.
-208,620. -208,620.
10,537.0.
10,537. 10,537.
3,237,675. 368,288. 0. 23,917.
10
Check here if following SOP 98-2 (ASC 958-720)
232010 12-10-12
Total functional expenses.
Joint costs.
(A) (B) (C) (D)
1
2
3
4
5
6
7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24
a
b
c
d
e
25
26
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Grants and other assistance to governments and
organizations in the United States. See Part IV, line 21
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Professional fundraising services. See Part IV, line 17
(If line 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch O.)
Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.)
Add lines 1 through 24e
Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part IX ��������������������������
Total expenses Program serviceexpenses
Management andgeneral expenses
Fundraisingexpenses
Grants and other assistance to individuals in
the United States. See Part IV, line 22 ~~~
Grants and other assistance to governments,
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16 ~
Benefits paid to or for members ~~~~~~~
Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~
~~~
Other salaries and wages ~~~~~~~~~~
Other employee benefits ~~~~~~~~~~
Payroll taxes ~~~~~~~~~~~~~~~~
Fees for services (non-employees):
Management
Legal
Accounting
Lobbying
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Investment management fees
Other.
~~~~~~~~
Advertising and promotion
Office expenses
Information technology
Royalties
~~~~~~~~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Occupancy ~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~Travel
Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings ~~
Interest
Payments to affiliates
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
Depreciation, depletion, and amortization
Insurance
~~
~~~~~~~~~~~~~~~~~
~~
All other expenses
|
Form (2012)
Do not include amounts reported on lines 6b,7b, 8b, 9b, and 10b of Part VIII.
10Part IX Statement of Functional Expenses
990
Respiratory Health Association 36-2222687
85,655. 85,655.
272,039. 272,039.
1,758,615. 1,241,208. 163,624. 353,783.
55,871. 40,497. 5,172. 10,202.135,487. 93,038. 14,767. 27,682.175,629. 129,343. 15,628. 30,658.
88,375. 72,595. 4,636. 11,144.21,000. 21,000.
185,738. 148,824. 10,845. 26,069.4,740. 4,740.
130,246. 101,405. 5,907. 22,934.
153,713. 132,001. 3,762. 17,950.65,210. 59,791. 2,794. 2,625.
67,587. 54,444. 13,143.
27,073. 19,422. 1,929. 5,722.
Printing & Postage 54,045. 43,414. 881. 9,750.Dues & Subscriptions 5,053. 1,541. 3,274. 238.Miscellaneous 3,592. 3,077. 189. 326.
3,289,668. 2,524,034. 233,408. 532,226.
11
23201112-10-12
(A) (B)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
1
2
3
4
5
6
7
8
9
10c
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
a
b
10a
10b
As
se
ts
Total assets.
Lia
bil
itie
s
Total liabilities.
Organizations that follow SFAS 117 (ASC 958), check here and
complete lines 27 through 29, and lines 33 and 34.
27
28
29
Organizations that do not follow SFAS 117 (ASC 958), check here
and complete lines 30 through 34.
30
31
32
33
34
Ne
t A
ss
ets
or
Fu
nd
Ba
lan
ce
s
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part X ������������������������������
Beginning of year End of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from other disqualified persons (as defined under
section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing
employers and sponsoring organizations of section 501(c)(9) voluntary
employees' beneficiary organizations (see instr). Complete Part II of Sch L ~~
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
Less: accumulated depreciation
~~~
~~~~~~
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~
Add lines 1 through 15 (must equal line 34) ����������
Accounts payable and accrued expenses
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~
Secured mortgages and notes payable to unrelated third parties ~~~~~~
Unsecured notes and loans payable to unrelated third parties ~~~~~~~~
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X of
Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 17 through 25 ������������������
|
Unrestricted net assets
Temporarily restricted net assets
Permanently restricted net assets
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
|
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~
Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~
Total liabilities and net assets/fund balances ����������������
Form (2012)
11Balance SheetPart X
990
Respiratory Health Association 36-2222687
487,384. 342,443.250,125. 189,505.40,880. 29,958.1,110. 81,648.
21,282. 15,388.
2,125,468.1,684,657. 427,074. 440,811.
1,836,110. 1,678,176.
1,431,175. 1,461,393.4,495,140. 4,239,322.985,050. 798,475.
948,112. 695,058.
1,933,162. 1,493,533.X
1,130,803. 1,284,396.
1,431,175. 1,461,393.
2,561,978. 2,745,789.4,495,140. 4,239,322.
12
23201212-10-12
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Yes No
1
2
3
a
b
c
2a
2b
2c
a
b
3a
3b
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part XI �����������������������������
Total revenue (must equal Part VIII, column (A), line 12)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other changes in net assets or fund balances (explain in Schedule O)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column (B))
~~~~~~~~~~~~~~~~~~~
�����������������������������������������������
Check if Schedule O contains a response to any question in this Part XII�����������������������������
Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits ����������������
Form (2012)
12Part XI Reconciliation of Net Assets
Part XII Financial Statements and Reporting
990
Respiratory Health Association 36-2222687
X
3,237,675.3,289,668.-51,993.
2,561,978.67,496.
168,308.
2,745,789.
X
X
X
X
X
X
X
13
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23202112-04-12
(iii)
(see instructions)
(iv) (i)
(v)
(i)
(vi)
(i)
(i) (ii) (vii)
(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.
Open to PublicInspection
Name of the organization Employer identification number
1
2
3
4
5
6
7
8
9
10
11
section 170(b)(1)(A)(i).
section 170(b)(1)(A)(ii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iv).
section 170(b)(1)(A)(v).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(vi).
section 509(a)(2).
section 509(a)(4).
section 509(a)(3).
a b c d
e
f
g
h
(i)
(ii)
(iii)
Yes No
11g(i)
11g(ii)
11g(iii)
Yes No Yes No Yes No
Total
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Schedule A (Form 990 or 990-EZ) 2012
Type of organization (described on lines 1-9 above or IRC section
)
Is the organizationin col. listed in yourgoverning document?
Did you notify theorganization in col.
of your support?
Is theorganization in col.
organized in theU.S.?
Name of supportedorganization
EIN Amount of monetarysupport
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
A church, convention of churches, or association of churches described in
A school described in (Attach Schedule E.)
A hospital or a cooperative hospital service organization described in
A medical research organization operated in conjunction with a hospital described in Enter the hospital's name,
city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
(Complete Part II.)
A federal, state, or local government or governmental unit described in
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
(Complete Part II.)
A community trust described in (Complete Part II.)
An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or
more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
Type I Type II Type III - Functionally integrated Type III - Non-functionally integrated
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
the governing body of the supported organization?
A family member of a person described in (i) above?
A 35% controlled entity of a person described in (i) or (ii) above?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~
Provide the following information about the supported organization(s).
LHA
SCHEDULE A
Part I Reason for Public Charity Status
Public Charity Status and Public Support 2012
Respiratory Health Association 36-2222687
X
14
Subtract line 5 from line 4.
23202212-04-12
Calendar year (or fiscal year beginning in)
Calendar year (or fiscal year beginning in) |
2
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
Total.
6 Public support.
(a) (b) (c) (d) (e) (f)
7
8
9
10
11
12
13
Total support.
12
First five years.
stop here
14
15
14
15
16
17
18
a
b
a
b
33 1/3% support test - 2012.
stop here.
33 1/3% support test - 2011.
stop here.
10% -facts-and-circumstances test - 2012.
stop here.
10% -facts-and-circumstances test - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
|
Add lines 7 through 10
Schedule A (Form 990 or 990-EZ) 2012 Page
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization
fails to qualify under the tests listed below, please complete Part III.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
Add lines 1 through 3 ~~~
The portion of total contributions
by each person (other than a
governmental unit or publicly
supported organization) included
on line 1 that exceeds 2% of the
amount shown on line 11,
column (f) ~~~~~~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 4 ~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~
Net income from unrelated business
activities, whether or not the
business is regularly carried on ~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.) ~~~~
Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and ��������������������������������������������� |
~~~~~~~~~~~~Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
Public support percentage from 2011 Schedule A, Part II, line 14
%
%~~~~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part IV how the organization
meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part IV how the
organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ��� |
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Respiratory Health Association 36-2222687
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
26,147,638.
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
298,398. 286,086. 289,975. 278,742. 256,636. 1,409,837.
27,557,475.
94.8894.94
X
15
(Subtract line 7c from line 6.)
Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
amount on line 13 for the year
(Add lines 9, 10c, 11, and 12.)
232023 12-04-12
Calendar year (or fiscal year beginning in) |
Calendar year (or fiscal year beginning in) |
Total support.
3
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
6
7
Total.
a
b
c
8 Public support
(a) (b) (c) (d) (e) (f)
9
10a
b
c11
12
13
14 First five years.
stop here
15
16
15
16
17
18
19
20
2012
2011
17
18
a
b
33 1/3% support tests - 2012.
stop here.
33 1/3% support tests - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975
Schedule A (Form 990 or 990-EZ) 2012 Page
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to
qualify under the tests listed below, please complete Part II.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose
Gross receipts from activities that
are not an unrelated trade or bus-
iness under section 513 ~~~~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
~~~ Add lines 1 through 5
Amounts included on lines 1, 2, and
3 received from disqualified persons
~~~~~~
Add lines 7a and 7b ~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 6 ~~~~~~~Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~
~~~~
Add lines 10a and 10b ~~~~~~Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part IV.) ~~~~
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and ���������������������������������������������������� |
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
Public support percentage from 2011 Schedule A, Part III, line 15
~~~~~~~~~~~~ %
%��������������������
Investment income percentage for (line 10c, column (f) divided by line 13, column (f))
Investment income percentage from Schedule A, Part III, line 17
~~~~~~~~ %
%~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~ |
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization~~~~ |
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions �������� |
Part III Support Schedule for Organizations Described in Section 509(a)(2)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
16
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Department of the TreasuryInternal Revenue Service
22345112-21-12
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(Form 990, 990-EZ,or 990-PF) | Attach to Form 990, Form 990-EZ, or Form 990-PF.
Name of the organization Employer identification number
Organization type
Filers of: Section:
not
General Rule Special Rule.
Note.
General Rule
Special Rules
(1) (2)
General Rule
Caution.
must
For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF.
exclusively
exclusively exclusively
(check one):
Form 990 or 990-EZ 501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust treated as a private foundation
527 political organization
Form 990-PF 501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
Check if your organization is covered by the or a
Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one
contributor. Complete Parts I and II.
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections
509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2%
of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
total contributions of more than $1,000 for use for religious, charitable, scientific, literary, or educational purposes, or
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
contributions for use for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000.
If this box is checked, enter here the total contributions that were received during the year for an religious, charitable, etc.,
purpose. Do not complete any of the parts unless the applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year ~~~~~~~~~~~~~~~~~ | $
An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF),
but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2 of its Form 990-PF, to
certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA
Schedule B Schedule of Contributors
2012
Respiratory Health Association 36-2222687
X 3
X
223452 12-21-12
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
2
Part I Contributors
Respiratory Health Association 36-2222687
1 Cook County of Illinois X
118 N. Clark Street Room 500 772,307.
Chicago, IL 60602
2 Mary Medlock Trust X
JP Morgan Chase 270 Park 75,761.
New York, NY 10017
3 DuPage County X
111 North County Farm Road 59,994.
Wheaton, IL 60187
18
223453 12-21-12
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
(see instructions). Use duplicate copies of Part II if additional space is needed.
$
$
$
$
$
$
3
Part II Noncash Property
Respiratory Health Association 36-2222687
19
(Enter this information once.)
223454 12-21-12
Name of organization Employer identification number
religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations that total more than $1,000 for theyear. (a) (e) and
$1,000 or less
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
exclusively Complete columns through the following line entry. For organizations completing Part III, enter
the total of religious, charitable, etc., contributions of for the year.
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
| $
Use duplicate copies of Part III if additional space is needed.
Exclusively
4
Part III
Respiratory Health Association 36-2222687
20
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23204101-07-13
(Form 990 or 990-EZ)For Organizations Exempt From Income Tax Under section 501(c) and section 527
Open to PublicInspection
Complete if the organization is described below. Attach to Form 990 or Form 990-EZ.
| See separate instructions.
If the organization answered "Yes," to Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
If the organization answered "Yes," to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
If the organization answered "Yes," to Form 990, Part IV, line 5 (Proxy Tax), or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Employer identification number
1
2
3
1
2
3
4
Yes No
a
b
Yes No
1
2
3
4
5
Form 1120-POL Yes No
(a) (b) (c) (d) (e)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule C (Form 990 or 990-EZ) 2012
¥ Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
¥ Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
¥ Section 527 organizations: Complete Part I-A only.
¥ Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
¥ Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
¥ Section 501(c)(4), (5), or (6) organizations: Complete Part III.Name of organization
Provide a description of the organization's direct and indirect political campaign activities in Part IV.
Political expenditures
Volunteer hours
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of any excise tax incurred by the organization under section 4955
Enter the amount of any excise tax incurred by organization managers under section 4955
If the organization incurred a section 4955 tax, did it file Form 4720 for this year?
~~~~~~~~~~~~~ $
~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~
Was a correction made?
If "Yes," describe in Part IV.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount directly expended by the filing organization for section 527 exempt function activities
Enter the amount of the filing organization's funds contributed to other organizations for section 527
exempt function activities
~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL,
line 17b
Did the filing organization file for this year?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization
made payments. For each organization listed, enter the amount paid from the filing organization's funds. Also enter the amount of political
contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a
political action committee (PAC). If additional space is needed, provide information in Part IV.
Name Address EIN Amount paid fromfiling organization's
funds. If none, enter -0-.
Amount of politicalcontributions received and
promptly and directlydelivered to a separatepolitical organization.
If none, enter -0-.
LHA
SCHEDULE C
Part I-A Complete if the organization is exempt under section 501(c) or is a section 527 organization.
Part I-B Complete if the organization is exempt under section 501(c)(3).
Part I-C Complete if the organization is exempt under section 501(c), except section 501(c)(3).
Political Campaign and Lobbying Activities2012
J J
J
JJ
J
J
J
Respiratory Health Association 36-2222687
21
23204201-07-13
If the amount on line 1e, column (a) or (b) is:
2
A
B
Limits on Lobbying Expenditures(The term "expenditures" means amounts paid or incurred.)
(a) (b)
1a
b
c
d
e
f
The lobbying nontaxable amount is:
g
h
i
j
Yes No
4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
(a) (b) (c) (d) (e)
2a
b
c
d
e
f
Schedule C (Form 990 or 990-EZ) 2012
Schedule C (Form 990 or 990-EZ) 2012 Page
Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN,
expenses, and share of excess lobbying expenditures).
Check if the filing organization checked box A and "limited control" provisions apply.
Filingorganization's
totals
Affiliated grouptotals
Total lobbying expenditures to influence public opinion (grass roots lobbying)
Total lobbying expenditures to influence a legislative body (direct lobbying)
~~~~~~~~~~
~~~~~~~~~~~
Total lobbying expenditures (add lines 1a and 1b)
Other exempt purpose expenditures
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total exempt purpose expenditures (add lines 1c and 1d)
Lobbying nontaxable amount. Enter the amount from the following table in both columns.
~~~~~~~~~~~~~~~~~~~~
Not over $500,000
Over $500,000 but not over $1,000,000
Over $1,000,000 but not over $1,500,000
Over $1,500,000 but not over $17,000,000
Over $17,000,000
20% of the amount on line 1e.
$100,000 plus 15% of the excess over $500,000.
$175,000 plus 10% of the excess over $1,000,000.
$225,000 plus 5% of the excess over $1,500,000.
$1,000,000.
Grassroots nontaxable amount (enter 25% of line 1f)
Subtract line 1g from line 1a. If zero or less, enter -0-
Subtract line 1f from line 1c. If zero or less, enter -0-
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~
If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720
reporting section 4911 tax for this year? ��������������������������������������
Calendar year (or fiscal year beginning in)
2009 2010 2011 2012 Total
Lobbying nontaxable amount
Lobbying ceiling amount
(150% of line 2a, column(e))
Total lobbying expenditures
Grassroots nontaxable amount
Grassroots ceiling amount
(150% of line 2d, column (e))
Grassroots lobbying expenditures
Part II-A Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
J
J
Respiratory Health Association 36-2222687
22
23204301-07-13
3
(a) (b)
Yes No Amount
1
a
b
c
d
e
f
g
h
i
j
a
b
c
d
2
Yes No
1
2
3
1
2
3
1
2
3
4
5
(do not include amounts of political
expenses for which the section 527(f) tax was paid).
1
2a
2b
2c
3
4
5
a
b
c
Schedule C (Form 990 or 990-EZ) 2012
For each "Yes," response to lines 1a through 1i below, provide in Part IV a detailed descriptionof the lobbying activity.
Schedule C (Form 990 or 990-EZ) 2012 Page
During the year, did the filing organization attempt to influence foreign, national, state or
local legislation, including any attempt to influence public opinion on a legislative matter
or referendum, through the use of:
Volunteers?
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?
Media advertisements?
Mailings to members, legislators, or the public?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
Publications, or published or broadcast statements?
Grants to other organizations for lobbying purposes?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Direct contact with legislators, their staffs, government officials, or a legislative body?
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means?
Other activities?
~~~~~~
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total. Add lines 1c through 1i
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)?
If "Yes," enter the amount of any tax incurred under section 4912
If "Yes," enter the amount of any tax incurred by organization managers under section 4912
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
~~~~~~~~~~~~~~~~
~~~
������
Were substantially all (90% or more) dues received nondeductible by members?
Did the organization make only in-house lobbying expenditures of $2,000 or less?
Did the organization agree to carry over lobbying and political expenditures from the prior year?
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
���������
Dues, assessments and similar amounts from members
Section 162(e) nondeductible lobbying and political expenditures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Current year
Carryover from last year
Total
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess
does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political
expenditure next year?
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Taxable amount of lobbying and political expenditures (see instructions) ���������������������
Complete this part to provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; Part II-A (affiliated group list); Part II-A, line 2;
and Part II-B, line 1. Also, complete this part for any additional information.
Part II-B Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768(election under section 501(h)).
Part III-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Part III-B Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No," OR (b) Part III-A, line 3, isanswered "Yes."
Part IV Supplemental Information
Respiratory Health Association 36-2222687
XX
XX 10,396.
XX
X 78,944.X 42,037.
X131,377.
X
Part II-B, Line 1(i), Other Lobbying Activities:
I. Local
A. Support local government spending policies that encourage the addition
of pollution control devices on diesel engines used in local government
construction projects.
23
23204401-07-13
4
Schedule C (Form 990 or 990-EZ) 2012
(continued)Schedule C (Form 990 or 990-EZ) 2012 Page
Part IV Supplemental Information
Respiratory Health Association 36-2222687
B. Seek support for smoking cessation and tobacco prevention programs.
II. State
A. Defense of a statewide smoke-free law.
B. Support an increase in tobacco taxes.
C. Support legislation monitoring radon.
D. Support legislation that restricts the sale of flavored tobacco.
E. Support legislation to create a fund to retrofit diesel engines with
pollution control devices.
III. Federal
A. Support more federal resources dedicated to lung disease.
B. Support development of a national COPD program.
C. Support the Lung Cancer Mortality Reduction Act.
D. Support the Family Asthma Act.
E. Support full funding of the Diesel Emissions Reduction Act.
24
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23205112-10-12
Held at the End of the Tax Year
(Form 990) | Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
| Attach to Form 990. | See separate instructions.Open to PublicInspection
Name of the organization Employer identification number
(a) (b)
1
2
3
4
5
6
Yes No
Yes No
1
2
3
4
5
6
7
8
9
a
b
c
d
2a
2b
2c
2d
Yes No
Yes No
1
2
a
b
(i)
(ii)
a
b
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2012
Complete if the
organization answered "Yes" to Form 990, Part IV, line 6.
Donor advised funds Funds and other accounts
Total number at end of year
Aggregate contributions to (during year)
Aggregate grants from (during year)
Aggregate value at end of year
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
~~~~~~~~~~~~~
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds
are the organization's property, subject to the organization's exclusive legal control?~~~~~~~~~~~~~~~~~~
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit? ��������������������������������������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of an historically important land area
Preservation of a certified historic structure
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
day of the tax year.
Total number of conservation easements
Total acreage restricted by conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
Number of states where property subject to conservation easement is located |
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year |
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year | $
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
LHA
Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Part II Conservation Easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
SCHEDULE D Supplemental Financial Statements 2012
Respiratory Health Association 36-2222687
25
23205212-10-12
3
4
5
a
b
c
d
e
Yes No
1
2
a
b
c
d
e
f
a
b
Yes No
1c
1d
1e
1f
Yes No
(a) (b) (c) (d) (e)
1
2
3
4
a
b
c
d
e
f
g
a
b
c
a
b
Yes No
(i)
(ii)
3a(i)
3a(ii)
3b
(a) (b) (c) (d)
1a
b
c
d
e
Total.
Schedule D (Form 990) 2012
(continued)
(Column (d) must equal Form 990, Part X, column (B), line 10(c).)
Two years back Three years back Four years back
Schedule D (Form 990) 2012 Page
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items
(check all that apply):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange programs
Other
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets
to be sold to raise funds rather than to be maintained as part of the organization's collection? ������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 9, orreported an amount on Form 990, Part X, line 21.
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
If "Yes," explain the arrangement in Part XIII and complete the following table:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amount
Beginning balance
Additions during the year
Distributions during the year
Ending balance
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization include an amount on Form 990, Part X, line 21?
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII
~~~~~~~~~~~~~~~~~~~~~~~~~
�������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
Current year Prior year
Beginning of year balance
Contributions
Net investment earnings, gains, and losses
Grants or scholarships
~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment
Permanent endowment
Temporarily restricted endowment
The percentages in lines 2a, 2b, and 2c should equal 100%.
| %
| %
| %
Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
unrelated organizations
related organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIII the intended uses of the organization's endowment funds.
~~~~~~~~~~~~~~~~~~~~~~
See Form 990, Part X, line 10.
Description of property Cost or otherbasis (investment)
Cost or otherbasis (other)
Accumulateddepreciation
Book value
Land
Buildings
Leasehold improvements
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Equipment
Other
~~~~~~~~~~~~~~~~~
��������������������
Add lines 1a through 1e. |������������
2Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
Part IV Escrow and Custodial Arrangements.
Part V Endowment Funds.
Part VI Land, Buildings, and Equipment.
Respiratory Health Association 36-2222687
230,155. 230,155.437,495. 437,495. 0.777,154. 629,924. 147,230.586,661. 573,207. 13,454.94,003. 44,031. 49,972.
440,811.
26
(including name of security)
23205312-10-12
Total.
Total.
(a) (b) (c)
(a) (b) (c)
(a) (b)
Total.
(a) (b) 1.
Total.
2.
Schedule D (Form 990) 2012
(Column (b) must equal Form 990, Part X, col. (B) line 15.)
(Column (b) must equal Form 990, Part X, col. (B) line 25.)
Description of security or category
(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Schedule D (Form 990) 2012 Page
See Form 990, Part X, line 12.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
Financial derivatives
Closely-held equity interests
Other
~~~~~~~~~~~~~~~
~~~~~~~~~~~
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Description of investment typeSee Form 990, Part X, line 13.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
See Form 990, Part X, line 15.
Description Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
���������������������������� |
See Form 990, Part X, line 25.
Description of liability Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Federal income taxes
����� |
FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's
liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ������
3Part VII Investments - Other Securities.
Part VIII Investments - Program Related.
Part IX Other Assets.
Part X Other Liabilities.
Respiratory Health Association 36-2222687
Beneficial Interest in Irrevocable Trust 1,461,393.
1,461,393.
X
27
23205412-10-12
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d 2e
32e 1
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d
2e 1
2e
3
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
Schedule D (Form 990) 2012
(This must equal Form 990, Part I, line 12.)
(This must equal Form 990, Part I, line 18.)
Schedule D (Form 990) 2012 Page
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
~~~~~~~~~~~~~~~~~~~
Net unrealized gains on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part VIII, line 12, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total revenue. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
�����������������
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through
Subtract line from line
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part IX, line 25, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total expenses. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
����������������
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part
X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
4Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
Part XIII Supplemental Information
Respiratory Health Association 36-2222687
3,589,862.
67,496.
284,691.352,187.
3,237,675.
0.3,237,675.
3,406,051.
116,383.116,383.
3,289,668.
0.3,289,668.
Part X, Line 2: The Association is exempt from federal income taxes
under Section 501(c)(3) of the Internal Revenue Code and applicable state
law. Accordingly, no provision for such taxes has been recognized in these
financial statements.
Accounting standards on accounting for uncertainty in income taxes
addresses the determination of whether tax benefits claimed or expected to
be claimed on a tax return should be recorded in the financial statements.
28
23205512-10-12
5
Schedule D (Form 990) 2012
(continued)Schedule D (Form 990) 2012 Page Part XIII Supplemental Information
Respiratory Health Association 36-2222687
Under this guidance, the Association may recognize the tax benefit from an
uncertain tax position only if it is more likely than not that the tax
position will be sustained on examination by taxing authorities, based on
the technical merits of the position. Examples of tax positions include
the tax-exempt status of the Association and various positions related to
the potential sources of unrelated business income tax. The tax benefits
recognized in the financial statements from any such position are measured
based on the largest benefit that has a greater than 50 percent likelihood
of being realized upon ultimate settlement. The Association has reviewed
the tax positions for the open tax years (current and prior three tax
years) and has concluded that no provision for income tax is required in
the financial statements. There were no unrecognized tax benefits
identified or recorded as liabilities during the period covered by these
financial statements.
Forms 990 filed by the Association are subject to examiniation by the
Internal Revenue Service up to three years from the extended due date of
each return. Forms 990 filed by the Association are generally no longer
subject to examination for the years 2008 and prior.
Part XI, Line 2d - Other Adjustments:
Rental real estate expenses 116,383.
Increase in value of beneficial interest in irrevocable
trust 30,218.
Adjustment to pension liability 138,090.
Total to Schedule D, Part XI, Line 2d 284,691.
Part XII, Line 2d - Other Adjustments:
29
23205512-10-12
5
Schedule D (Form 990) 2012
(continued)Schedule D (Form 990) 2012 Page Part XIII Supplemental Information
Respiratory Health Association 36-2222687
Rental real estate expenses 116,383.
30
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Didfundraiser
have custodyor control of
contributions?
23208101-07-13
Schedule G (Form 990 or 990-EZ) 2012
(Form 990 or 990-EZ)
Open To PublicInspection
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.Employer identification number
1
a
b
c
d
a
b
e
f
g
2
Yes No
(i) (ii)
(iii) (iv)
(v)
(i)
(vi)
Yes No
Total
3
Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Name of the organization
Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are notrequired to complete this part.
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
Mail solicitations
Internet and email solicitations
Phone solicitations
In-person solicitations
Solicitation of non-government grants
Solicitation of government grants
Special fundraising events
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or
key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
Name and address of individualor entity (fundraiser)
ActivityGross receipts
from activity
Amount paidto (or retained by)
fundraiserlisted in col.
Amount paidto (or retained by)
organization
�������������������������������������� |
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registrationor licensing.
LHA
SCHEDULE G
Fundraising Activities. Part I
Supplemental Information RegardingFundraising or Gaming Activities 2012
Respiratory Health Association 36-2222687
31
232082 01-07-13
2
(d)
(a)
(c)
(a) (b) (c)
1
2
3
4
5
6
7
8
9
10
11
(a) (b)
(c) (d)
(a) (c)
1
2
3
4
5
6
7
8
Yes Yes Yes
No No No
9
10
a
b
Yes No
a
b
Yes No
Schedule G (Form 990 or 990-EZ) 2012
Pull tabs/instantbingo/progressive bingo
Schedule G (Form 990 or 990-EZ) 2012 Page Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000
of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
Total events
(add col. through
col. )
Re
ven
ue
Event #1 Event #2 Other events
(event type) (event type) (total number)
Gross receipts
Less: Contributions
~~~~~~~~~~~~~~
~~~~~~~~~~~
Gross income (line 1 minus line 2)
Dir
ec
t E
xpe
nse
s
����
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs ~~~~~~~~~~~~
Food and beverages
Entertainment
~~~~~~~~~~
~~~~~~~~~~~~~~
Other direct expenses ~~~~~~~~~~
Direct expense summary. Add lines 4 through 9 in column (d)
Net income summary. Combine line 3, column (d), and line 10
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
������������������������� |Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than
$15,000 on Form 990-EZ, line 6a.
Re
ven
ue Bingo Other gaming
Total gaming (addcol. through col. )
Dir
ec
t E
xpe
nse
s
Gross revenue ��������������
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs
Other direct expenses
~~~~~~~~~~~~
����������
% % %
Volunteer labor ~~~~~~~~~~~~~
Direct expense summary. Add lines 2 through 5 in column (d)
Net gaming income summary. Combine line 1, column d, and line 7
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
��������������������� |
Enter the state(s) in which the organization operates gaming activities:
Is the organization licensed to operate gaming activities in each of these states?
If "No," explain:
~~~~~~~~~~~~~~~~~~~~
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
If "Yes," explain:
~~~~~~~~~
Part II Fundraising Events.
Part III Gaming.
Respiratory Health Association 36-2222687
Hustle UpThe Hancock
SkylinePlunge 4
1,194,427. 182,028. 393,507. 1,769,962.
966,242. 167,928. 341,821. 1,475,991.
228,185. 14,100. 51,686. 293,971.
224,057. 132,755. 145,779. 502,591.502,591.
-208,620.
32
232083 01-07-13
3
11
12
13
14
15
Yes No
Yes No
a
b
13a
13b
Yes Noa
b
c
16
17
a
b
Yes No
Supplemental Information.
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012 Page
Does the organization operate gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed
to administer charitable gaming?
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the percentage of gaming activity operated in:
The organization's facility
An outside facility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ %
%~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address |
Does the organization have a contract with a third party from whom the organization receives gaming revenue?
If "Yes," enter the amount of gaming revenue received by the organization |
~~~~~~
$ and the amount
of gaming revenue retained by the third party | $ .
If "Yes," enter name and address of the third party:
Name |
Address |
Gaming manager information:
Name |
Gaming manager compensation |
Description of services provided |
$
Director/officer Employee Independent contractor
Mandatory distributions:
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year | $
Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III,
lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Part IV
Respiratory Health Association 36-2222687
33
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
23210112-18-12
Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States
SCHEDULE I(Form 990)
Complete if the organization answered "Yes" to Form 990, Part IV, line 21 or 22.
| Attach to Form 990.
Open to PublicInspection
Employer identification number
General Information on Grants and AssistancePart I
1
2
Yes No
Part II Grants and Other Assistance to Governments and Organizations in the United States.
(f) 1 (a) (b) (c) (d) (e) (g) (h)
2
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (2012)
Name of the organization
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and the selection
criteria used to award the grants or assistance? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Complete if the organization answered "Yes" to Form 990, Part IV, line 21, for any
recipient that received more than $5,000. Part II can be duplicated if additional space is needed.Method of
valuation (book,FMV, appraisal,
other)
Name and address of organizationor government
EIN IRC sectionif applicable
Amount ofcash grant
Amount ofnon-cash
assistance
Description ofnon-cash assistance
Purpose of grantor assistance
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table
Enter total number of other organizations listed in the line 1 table
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
�������������������������������������������������� |
LHA
2012
Respiratory Health Association 36-2222687
X
To fund research forFoundation of American Thoracic Illinois basedSociety - 25 Broadway, 18th Floor investigators in Chronic- NEW YORK, NY 10004 06-5148706 501(c)(3) 25,000. 0. Obstructive Pulmonary
The Chest Foundation To help reduce tobacco3300 Dundee Road use in the ChicagolandNORTHBROOK, IL 60062 32-3286520 501(c)(3) 5,000. 0. area
2.0.
See Part IV for Column (h) descriptions 34
232102 12-18-12
2Part III Grants and Other Assistance to Individuals in the United States.
(e) (a) (b) (c) (d) (f)
Part IV Supplemental Information.
Schedule I (Form 990) (2012)
Schedule I (Form 990) (2012) Page Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
Method of valuation(book, FMV, appraisal, other)
Type of grant or assistance Number ofrecipients
Amount ofcash grant
Amount of non-cash assistance
Description of non-cash assistance
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Respiratory Health Association 36-2222687
Schedule I, Part I, Line 2: Schedule I, Part I, Line 2:
Research grant applications are reviewed by a committee consisting of
various health professionals and the association. Ongoing monitoring and
final results are managed by the appropriate designee on the committee.
Part II, line 1, Column (h):
Name of Organization or Government:
Foundation of American Thoracic Society
(h) Purpose of Grant or Assistance: To fund research for Illinois based 35
23229105-01-12
2
Schedule I (Form 990)
Schedule I (Form 990) Page
Part IV Supplemental Information
Respiratory Health Association 36-2222687
investigators in Chronic Obstructive Pulmonary Disease (COPD)
36
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23211112-10-12
For certain Officers, Directors, Trustees, Key Employees, and HighestCompensated Employees
Complete if the organization answered "Yes" to Form 990,Part IV, line 23. Open to Public
InspectionAttach to Form 990. See separate instructions.Employer identification number
Yes No
1a
b
1b
2
2
3
4
a
b
c
4a
4b
4c
Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9.
5
5a
5b
6a
6b
7
8
9
a
b
6
a
b
7
8
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2012
|
| |Name of the organization
Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990,
Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Travel for companions
Housing allowance or residence for personal use
Payments for business use of personal residence
Tax indemnification and gross-up payments
Discretionary spending account
Health or social club dues or initiation fees
Personal services (e.g., maid, chauffeur, chef)
If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or
reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain~~~~~~~~~~~
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors,
trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ~~~~~~~~~~~~~~~~~~~~~
Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's
CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to
establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Independent compensation consultant
Form 990 of other organizations
Written employment contract
Compensation survey or study
Approval by the board or compensation committee
During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing
organization or a related organization:
Receive a severance payment or change-of-control payment?
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
Participate in, or receive payment from, an equity-based compensation arrangement?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the revenues of:
The organization?
Any related organization?
If "Yes" to line 5a or 5b, describe in Part III.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the net earnings of:
The organization?
Any related organization?
If "Yes" to line 6a or 6b, describe in Part III.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed payments
not described in lines 5 and 6? If "Yes," describe in Part III
Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the
initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in
Regulations section 53.4958-6(c)? ���������������������������������������������
LHA
SCHEDULE J(Form 990)
Part I Questions Regarding Compensation
Compensation Information
2012
Respiratory Health Association 36-2222687
XX X
X
XXX
XX
XX
X
X
37
23211212-12-12
2
Part II Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Note.
(B) (C) (D) (E) (F)
(i) (ii) (iii) (A)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
Schedule J (Form 990) 2012
Schedule J (Form 990) 2012 Page
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii).Do not list any individuals that are not listed on Form 990, Part VII.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
Breakdown of W-2 and/or 1099-MISC compensation Retirement andother deferredcompensation
Nontaxablebenefits
Total of columns(B)(i)-(D)
Compensationreported as deferred
in prior Form 990Basecompensation
Bonus &incentive
compensation
Otherreportable
compensation
Name and Title
Respiratory Health Association 36-2222687
(1) Joel J. Africk 251,613. 0. 7,643. 0. 12,783. 272,039. 0.President & CEO 0. 0. 0. 0. 0. 0. 0.
38
23211312-10-12
3
Part III Supplemental Information
Schedule J (Form 990) 2012
Schedule J (Form 990) 2012 Page
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for anyadditional information.
Respiratory Health Association 36-2222687
Part I, Line 3: Compensation committee approves the CEO salary and
conducts performance reviews.
39
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23221101-04-13
(Form 990 or 990-EZ) Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.
| Attach to Form 990 or 990-EZ.Open to PublicInspection
Employer identification number
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization
LHA
SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2012
Respiratory Health Association 36-2222687
Form 990, Part III, Line 4b, Program Service Accomplishments:
Through partnerships with the city and county, as well as with private
businesses and other local health departments and hospitals,
Respiratory Health Association provides "Courage to Quit" smoking
cessation classes and "Intro to Tobacco-Free Living" workshops for
adults, as well as the "Operation Storefront" curriculum that
introduces teens to the tactics of tobacco-industry marketing toward
their age group, and encourages them to make the choice to stay
tobacco-free. In addition, Respiratory Health Association partners with
health departments and other community stakeholders to promote
smoke-free environments, including smoke-free housing.
These programmatic efforts are complemented by several policy
initiatives to increase smoke free environments (including parks) and
to resist efforts to create exemptions in the Illinois Clean Indoor Air
Law, which we helped pass in 2007.
Form 990, Part III, Line 4c, Program Service Accomplishments:
lawmakers were asked to support funds to clean up diesel vehicle
fleets, requirements that clean construction vehicles be used on
federally funded projects, and strategies to address global warming and
clean energy.
Form 990, Part III, Line 4d, Other Program Services:
Research: Advance the understanding and treatment of lung diseases by
supporting scientifically meritorious research.
40
23221201-04-13
2
Employer identification number
Schedule O (Form 990 or 990-EZ) (2012)
Schedule O (Form 990 or 990-EZ) (2012) Page
Name of the organizationRespiratory Health Association 36-2222687
Research on a wide range of lung disease issues is considered,
including asthma, lung cancer, COPD, interstitial lung disease
(including pulmonary fibrosis) and women's lung health.
Respiratory Health Association aims to fund the most promising research
and strives to foster greater collaboration among researchers and among
organizations that support lung disease research. Through the
development of partnerships with other research organizations,
Respiratory Health Association is able to maximize research awards and
make every dollar raised go farther.
Research funded by Respiratory Health Association helps scientists
diagnose lung disease earlier, discover causes and find cures. The goal
is to help improve the quality of life for those living with lung
disease. Recently funded projects include efforts at University of
Chicago, University of Illinois at Chicago, Rush University Medical
Center and Northwestern University.
Expenses $ 64,043. including grants of $ 30,000. Revenue $ 3,388.
Form 990, Part VI, Section B, line 11: The CEO and Director of Finance and
Grant Administration reviewed Form 990 before providing to the Board of
Directors of the organization. The Board reviewed and approved Form 990
before filing.
Form 990, Part VI, Section B, Line 12c: All members of the Board of
Directors are required to complete a conflict of interest statement each
year identifying any interests that could give rise to conflicts. These
41
23221201-04-13
2
Employer identification number
Schedule O (Form 990 or 990-EZ) (2012)
Schedule O (Form 990 or 990-EZ) (2012) Page
Name of the organizationRespiratory Health Association 36-2222687
forms are reviewed by the CEO and lists of potential conflicts are prepared
and used to monitor their involvement with decisions throughout the year.
Should a conflict of interest arise, the appropriate member of the Board of
Directors would be excluded from voting on the related or transaction.
Form 990, Part VI, Section B, Line 15a: The Board has established a CEO
performance review and compensation committee consisting of six officers of
the Board. The committee meets at least once annually to review the CEO's
performance and make any adjustments to CEO compensation. The committee
reviews and considers salary survey results and data regarding compensation
of top management officials at similarly sized non-profit organizations in
metropolitan Chicago. The committee also reviews and considers progress
toward individual and organizational goals, and the financial strength of
the organization. Periodically, the committee has engaged a compensation
consultant to undertake an independent review of the CEO's compensation and
to make recommendations regarding compensation adjustments.
Form 990, Part VI, Section C, Line 19: The Association's financial
statements are contained in the annual report and are available to the
public on the Association's website or upon request. The Association's
governing documents and conflict of interest policy are made available to
the public on request.
Form 990, Part XI, line 9, Changes in Net Assets:
Increase (Decrease) in value of beneficial interest in
irrevocable trust 30,218.
Adjustment to pension liability 138,090.
Total to Form 990, Part XI, Line 9 168,308.
42
Department of the TreasuryInternal Revenue Service
File by thedue date forfiling yourreturn. Seeinstructions.
22384101-21-13
| File a separate application for each return.
Automatic 3-Month Extension, complete only Part I
Additional (Not Automatic) 3-Month Extension, complete only Part II
Electronic filing .
Type or
Application
Is For
Return
Code
Application
Is For
Return
Code
1
2
3a
b
c
3a
3b
3c
$
$
$
Balance due.
Caution.
For Privacy Act and Paperwork Reduction Act Notice, see instructions. 8868
www.irs.gov/efile e-file for Charities & Nonprofits.
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of timeto file income tax returns.
Form
(Rev. January 2013) OMB No. 1545-1709
¥ If you are filing for an and check this box ~~~~~~~~~~~~~~~~~~~ |
¥ If you are filing for an (on page 2 of this form).
you have already been granted an automatic 3-month extension on a previously filed Form 8868.
You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation
required to file Form 990-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension
of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain
Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form,
visit and click on
A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete
Part I only ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
Name of exempt organization or other filer, see instructions. Employer identification number (EIN) or
Number, street, and room or suite no. If a P.O. box, see instructions.
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
Social security number (SSN)
Enter the Return code for the return that this application is for (file a separate application for each return) ~~~~~~~~~~~~~~~~~
Form 990 or Form 990-EZ
Form 990-BL
Form 4720 (individual)
Form 990-PF
01
02
03
04
05
06
Form 990-T (corporation) 07
08
09
10
11
12
Form 1041-A
Form 4720
Form 5227
Form 6069
Form 8870
Form 990-T (sec. 401(a) or 408(a) trust)
Form 990-T (trust other than above)
¥ The books are in the care of |
Telephone No. | FAX No. |
¥ If the organization does not have an office or place of business in the United States, check this box~~~~~~~~~~~~~~~~~ |
¥ If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box . If it is for part of the group, check this box and attach a list with the names and EINs of all members the extension is for.| |
I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time until
, to file the exempt organization return for the organization named above. The extension
is for the organization's return for:
|
|
calendar year or
tax year beginning , and ending .
If the tax year entered in line 1 is for less than 12 months, check reason: Initial return Final return
Change in accounting period
If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions.
If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit.
Subtract line 3b from line 3a. Include your payment with this form, if required,
by using EFTPS (Electronic Federal Tax Payment System). See instructions.
If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions.
LHA Form (Rev. 1-2013)
Do not complete Part II unless (e-file)
Part I Automatic 3-Month Extension of Time. Only submit original (no copies needed).
8868 Application for Extension of Time To File anExempt Organization Return
X
Respiratory Health Association 36-2222687
1440 West Washington Boulevard
Chicago, IL 60607
0 1
Joel J. Africk1440 West Washington Boulevard - Chicago, IL 60607
(312)243-2000
February 15, 2014
X JUL 1, 2012 JUN 30, 2013
0.
0.
0.
42
20094105-01-12
~~~~~~~~~~~~~~~~~
FOR THE YEAR ENDING
Prepared for
Prepared by
Amount dueor refund
Make checkpayable to
Mail tax returnand check (ifapplicable) to
Return must bemailed onor before
SpecialInstructions
TAX RETURN FILING INSTRUCTIONSILLINOIS FORM AG990-IL
JUNE 30, 2013
RESPIRATORY HEALTH ASSOCIATION1440 WEST WASHINGTON BOULEVARDCHICAGO, IL 60607
MCGLADREY LLP1 S. WACKER DRIVE, STE 800CHICAGO, IL 60606
BALANCE DUE OF $15
ILLINOIS CHARITY BUREAU FUND
OFFICE OF THE ATTORNEY GENERALCHARITABLE TRUST BUREAU100 WEST RANDOLPH ST., 11TH FLOORCHICAGO, IL 60601-3175
PLEASE MAIL AS SOON AS POSSIBLE.
FORM AG990-IL SHOULD BE SIGNED AND DATED BY THE REQUIREDINDIVIDUAL(S).
INCLUDE THE ORGANIZATION'S ILLINOIS CHARITABLE ORGANIZATIONNUMBER AND "2012 FORM AG990-IL" ON THE REMITTANCE.
TO DOCUMENT THE TIMELY FILING OF YOUR TAX RETURN, WE SUGGESTTHAT YOU OBTAIN AND RETAIN PROOF OF MAILING. PROOF OF MAILINGCAN BE ACCOMPLISHED BY SENDING THE TAX RETURN BY REGISTERED ORCERTIFIED MAIL (METERED BY THE U.S. POSTAL SERVICE).
2980
91 0
5-01
-12
For Office Use Only
CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED)CODE CATEGORIES
List on back side of instructions
Check all items attached:
Make ChecksPayable tothe IllinoisCharityBureau Fund
J)
L)
O)
TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)
TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)
TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
PROFESSIONAL FUNDRAISERS:
PROFESSIONAL FUNDRAISING CONSULTANTS:
(GROSS AMTS.)
Form AG990-ILRevised 3/05
PMT #
AMT Copy of IRS Return
Audited Financial Statements
Copy of Form IFC
INIT $15.00 Annual Report Filing Fee
$100.00 Late Report Filing FeeMO DAY YRFederal ID # MO DAY YR
Yes NoAre contributions to the organization tax deductible? Date Organization was created:
LEGAL Year-endamountsNAME
A) ASSETS
B) LIABILITIES
C) NET ASSETS
A)
B)
C)
$
$
$
ADDRESS
CITY, STATE
ZIP CODE
PERCENTAGE AMOUNT
D)
E)
F)
G)
$
$
$
$
PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. D) %
%
%
%
E) GOVERNMENT GRANTS & MEMBERSHIP DUES
F) OTHER REVENUES
G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F) 100
H)
I)
J1)
K)
M)
N)
OPERATING CHARITABLE PROGRAM EXPENSE %
%
%
%
%
%
%
%
H)
I)
J)
K)
L)
M)
N)
O)
$
$
$
$
$
$
$
$
EDUCATION PROGRAM SERVICE EXPENSE
JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $
GRANTS TO OTHER CHARITABLE ORGANIZATIONS
MANAGEMENT AND GENERAL EXPENSE
FUNDRAISING EXPENSE
100
(Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
P)
Q)
R)
S)
$
$
$
$
TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERSP)
Q)
R)
100 %
%
%
TOTAL FUNDRAISERS FEES AND EXPENSES
NET RECEIVED BY THE CHARITY (P MINUS Q=R)
S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
T)
U)
V)
$
$
$
T)
U)
V)
NAME, TITLE:
NAME, TITLE:
NAME, TITLE:
CODE
W)
X)
Y)
#
#
#
DESCRIPTION:
DESCRIPTION:
DESCRIPTION:
W)
X)
Y)
ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORTAttorney General LISA MADIGAN State of Illinois
Charitable Trust Bureau, 100 West Randolph11th Floor, Chicago, Illinois 60601
CO #
Report for the Fiscal Period:
Beginning
& Ending
I.
II.
SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
V. CHARITABLE PROGRAM DESCRIPTION:
01-003,529
XX
07/01/2012X
06/30/201336-2222687
X
Respiratory Health Association4,239,322.
1440 West Washington Boulevard 1,493,533.Chicago, IL 2,745,789.60607
69.740 2,608,461.24.043 899,268.6.217 232,537.
3,740,266.
77.552 2,940,970.
77.552 2,940,970.
2.259 85,655.
79.811 3,026,625.
6.155 233,408.
14.035 532,226.
3,792,259.
0.
0.
Joel J. Africk, President & CEO 294,539.Audrey Eisenberg, Sr. Director Develop & Admin. 94,069.Gina Schwieger, Director Special Events 78,029.
Public Education 010Other Medical & Disease Research 053Public Policy 104
(PRINT NAME)
(PRINT NAME)
29810105-01-12 (PRINT NAME)
ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS
BE SURE TO INCLUDE ALL FEES DUE:
1.
2.
3.
4.
5.
6.
7a.
7b.
8.
9.
10.
11.
12.
WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? ~~~~~~~~~~~~~~~~ 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? ~~~~~~~~~~
DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS,
DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE
ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE
THAN 10% OF THE OUTSTANDING SHARES? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
OR ORGANIZATION? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC)~~~~~~~~~~~~~~~
DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ; (ii) THE AMOUNT
ALLOCATED TO PROGRAM SERVICES $
GENERAL $
; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $
DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES?~~~~~~~~~
HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
REVOKED BY ANY GOVERNMENTAL AGENCY? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION,
COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
THREE LARGEST ACCOUNTS:
NAME AND TELEPHONE NUMBER OF CONTACT PERSON:
UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHEDDOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THEILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE ANDAGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.
1.)
2.)3.)
REPORTS ARE DUE WITHIN SIXMONTHS OF YOUR FISCAL YEAR END.FOR FEES DUE SEE INSTRUCTIONS.
PRESIDENT or TRUSTEE SIGNATURE DATE
REPORTS THAT ARE LATE ORINCOMPLETE ARE SUBJECT TO A$100.00 PENALTY.
TREASURER or TRUSTEE SIGNATURE DATE
PREPARER SIGNATURE DATE
YES NOIF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:
X
X
X
X
X
X
X
X
X
X
Northern Trust Bank, 50 S. LaSalle Street, Chicago, IL
Morgan Stanley, 70 West Madison Street, Chicago, IL
Joel J. Africk - (312)243-2000
Joel J. Africk
Steven Victor
Wayne Harder
Checkifself-employed
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Check ifapplicable:
AddresschangeNamechangeInitialreturn
Termin-atedAmendedreturn Gross receipts $
Applica-tionpending
232001 12-10-12
Beginning of Current Year
Paid
Preparer
Use Only
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lungbenefit trust or private foundation)
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning and ending
B C D Employer identification number
E
G
H(a)
H(b)
H(c)
F Yes No
Yes No
I
J
K
Website: |
L M
1
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6
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3
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5
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7a
7b
a
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Ac
tivi
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s &
Go
vern
an
ce
Prior Year Current Year
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Re
ven
ue
a
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Ex
pe
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es
End of Year
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Sign
Here
Yes No
For Paperwork Reduction Act Notice, see the separate instructions.
|
(or P.O. box if mail is not delivered to street address) Room/suite
Are all affiliates included?
)501(c)(3) 501(c) ( (insert no.) 4947(a)(1) or 527
|Corporation Trust Association OtherForm of organization: Year of formation: State of legal domicile:
|
|
Net
Ass
ets
orFu
nd B
alan
ces
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Signature of officer Date
Type or print name and title
Date PTINPrint/Type preparer's name Preparer's signature
Firm's name Firm's EIN
Firm's address
Phone no.
Form
The organization may have to use a copy of this return to satisfy state reporting requirements.
Name of organization
Doing Business As
Number and street Telephone number
City, town, or post office, state, and ZIP code
Is this a group return
for affiliates?Name and address of principal officer:
If "No," attach a list. (see instructions)
Group exemption number |
Tax-exempt status:
Briefly describe the organization's mission or most significant activities:
Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2012 (Part V, line 2a)
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, line 34
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
����������������������
Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~
Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) ���
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
~~~~~~~~~~~
~~~~~~~~~~~~~
~~~
Professional fundraising fees (Part IX, column (A), line 11e)
Total fundraising expenses (Part IX, column (D), line 25)
~~~~~~~~~~~~~~
Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)
Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 18 from line 12
~~~~~~~~~~~~~
~~~~~~~
����������������
Total assets (Part X, line 16)
Total liabilities (Part X, line 26)
Net assets or fund balances. Subtract line 21 from line 20
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~
��������������
May the IRS discuss this return with the preparer shown above? (see instructions) ���������������������
LHA Form (2012)
Part I Summary
Signature BlockPart II
990
Return of Organization Exempt From Income Tax990 2012
§
==
999
JUL 1, 2012 JUN 30, 2013
Respiratory Health AssociationX 36-2222687
1440 West Washington Boulevard (312)243-20005,477,474.
Chicago, IL 60607Joel J. Africk X
same as C aboveX
www.lungchicago.orgX 1906 IL
To promote healthy lungs andfight lung disease through research, advocacy, and education.
323258
5000.0.
7,785,363. 2,845,470.922,742. 357,751.55,645. 135,563.
100,306. -101,109.8,864,056. 3,237,675.1,991,900. 85,655.
0. 0.3,035,420. 2,397,641.
0. 0.532,226.
3,703,838. 806,372.8,731,158. 3,289,668.132,898. -51,993.
4,495,140. 4,239,322.1,933,162. 1,493,533.2,561,978. 2,745,789.
Joel J. Africk, President & CEO
Wayne Harder P00294296MCGLADREY LLP 42-07143251 S. WACKER DRIVE, STE 800CHICAGO, IL 60606 312-634-3400
X
4
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Expenses $ including grants of $ Revenue $
23200212-10-12
1
2
3
4
Yes No
Yes No
4a
4b
4c
4d
4e Total program service expenses
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part III �����������������������������
Briefly describe the organization's mission:
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
If "Yes," describe these new services on Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
If "Yes," describe these changes on Schedule O.
~~~~~~
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
( ) ( ) ( )
( ) ( ) ( )
( ) ( ) ( )
Other program services (Describe in Schedule O.)
( ) ( )
Form (2012)
2Statement of Program Service AccomplishmentsPart III
990
J
Respiratory Health Association 36-2222687
X
To promote healthy lungs and fight lung disease through research,advocacy, and education.
X
X
1,511,521. 47,901. 216,510.Lung Health Programs: Reduce the burden of chronic disease (especiallyasthma, lung cancer, and COPD) throughout the community.
We use health educators and other trained staff/volunteers to educatecommunities about how they can address lung health disparities andeducate individuals about how to manage their lung disease. Currently,our programs and projects include: Fight Asthma Now (for youth/teens),Asthma Management (for caregivers), Asthma-Friendly Childcare Project,Addressing Asthma in Northern Lake County Project, COPD Initiativeincluding our Living Better Together COPD Conference, Healthy LungsInitiative, Radon Awareness efforts, etc.
700,174. 137,170.Tobacco Control: Reduce smoking rate, reduce exposure to secondhandsmoke and prevent youth from using tobacco.
Respiratory Health Association is collaborating with Chicago PublicSchools on a grant from the Centers for Disease Control and Preventionaimed at decreasing the smoking rate and exposure to secondhand smokeamong Chicago Public Schools students.
In addition, the Healthy Lungs Initiative, in collaboration with theCook County Health and Hospitals System, provides direct counseling andother resources to smokers who want to quit.
248,296. 7,754. 11,220.Environmental Health: Promote policies that improve indoor and outdoorair quality and raise awareness about how air pollution affects lunghealth.
In 2013 we supported educational/awareness activities to limit idlingby diesel vehicles and equipment and urged local and state governmentto adopt public contract requirements that require the use of cleanerdiesel construction equipment. We also worked to limit pollution bycoal-fired power plants throughout Illinois. We called for action toreduce air pollution from transit vehicles, including diesel buses andlocomotives, and initiated community-based awareness activities toinform local residents about risks to their lung health. Federal
64,043. 30,000. 3,388.2,524,034.
See Schedule O for Continuation(s) 5
23200312-10-12
Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1
2
3
4
5
6
7
8
9
10
Section 501(c)(3) organizations.
a
b
c
d
e
f
a
b
11a
11b
11c
11d
11e
11f
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
a
b
a
b
If "Yes," complete Schedule ASchedule B, Schedule of Contributors
If "Yes," complete Schedule C, Part I
If "Yes," complete Schedule C, Part II
If "Yes," complete Schedule C, Part III
If "Yes," complete Schedule D, Part I
If "Yes," complete Schedule D, Part IIIf "Yes," complete
Schedule D, Part III
If "Yes," complete Schedule D, Part IV
If "Yes," complete Schedule D, Part V
If "Yes," complete Schedule D,Part VI
If "Yes," complete Schedule D, Part VII
If "Yes," complete Schedule D, Part VIII
If "Yes," complete Schedule D, Part IXIf "Yes," complete Schedule D, Part X
If "Yes," complete Schedule D, Part XIf "Yes," complete
Schedule D, Parts XI and XII
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optionalIf "Yes," complete Schedule E
If "Yes," complete Schedule F, Parts I and IV
If "Yes," complete Schedule F, Parts II and IV
If "Yes," complete Schedule F, Parts III and IV
If "Yes," complete Schedule G, Part I
If "Yes," complete Schedule G, Part IIIf "Yes,"
complete Schedule G, Part IIIIf "Yes," complete Schedule H
Form 990 (2012) Page
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete ?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year?
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts?
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent
endowments, or quasi-endowments?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~
If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X
as applicable.
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total
assets reported in Part X, line 16?
Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total
assets reported in Part X, line 16?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in
Part X, line 16?
Did the organization report an amount for other liabilities in Part X, line 25?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?
Did the organization obtain separate, independent audited financial statements for the tax year?
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization included in consolidated, independent audited financial statements for the tax year?
~~~~~
Is the organization a school described in section 170(b)(1)(A)(ii)?
Did the organization maintain an office, employees, or agents outside of the United States?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization
or entity located outside the United States?
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals
located outside the United States?
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
Did the organization operate one or more hospital facilities?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ����������
Form (2012)
3Part IV Checklist of Required Schedules
990
Respiratory Health Association 36-2222687
XX
X
X
X
X
X
X
X
X
X
X
X
XX
X
X
XXX
X
X
X
X
X
XX
6
23200412-10-12
Yes No
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
21
22
23
24a
24b
24c
24d
25a
25b
26
27
28a
28b
28c
29
30
31
32
33
34
35a
35b
36
37
38
a
b
c
d
a
b
Section 501(c)(3) and 501(c)(4) organizations.
a
b
c
a
b
Section 501(c)(3) organizations.
Note.
(continued)
If "Yes," complete Schedule I, Parts I and II
If "Yes," complete Schedule I, Parts I and III
If "Yes," completeSchedule J
If "Yes," answer lines 24b through 24d and completeSchedule K. If "No", go to line 25
If "Yes," complete Schedule L, Part I
If "Yes," completeSchedule L, Part I
If "Yes," complete Schedule L, Part II
If "Yes," complete Schedule L, Part III
If "Yes," complete Schedule L, Part IVIf "Yes," complete Schedule L, Part IV
If "Yes," complete Schedule L, Part IVIf "Yes," complete Schedule M
If "Yes," complete Schedule M
If "Yes," complete Schedule N, Part IIf "Yes," complete
Schedule N, Part II
If "Yes," complete Schedule R, Part IIf "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part VI
Form 990 (2012) Page
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the
United States on Part IX, column (A), line 1? ~~~~~~~~~~~~~~~~~~
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX,
column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
Did the organization engage in an excess benefit transaction with a
disqualified person during the year?
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified
person outstanding as of the end of the organization's tax year?
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
of any of these persons?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, or key employee? ~~~~~~~~~~~
A family member of a current or former officer, director, trustee, or key employee?
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner?
~~
~~~~~~~~~~~~~~~~~~~~~
Did the organization receive more than $25,000 in non-cash contributions?
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions?
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization liquidate, terminate, or dissolve and cease operations?
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3?
Was the organization related to any tax-exempt or taxable entity?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)?
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Did the organization make any transfers to an exempt non-charitable related organization?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? ~~~~~~~~
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?
All Form 990 filers are required to complete Schedule O �������������������������������
Form (2012)
4Part IV Checklist of Required Schedules
990
Respiratory Health Association 36-2222687
X
X
X
X
X
X
X
X
XX
XX
X
X
X
X
XX
X
X
X
7
23200512-10-12
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations.
Yes No
1
2
3
4
5
6
7
a
b
c
1a
1b
1c
a
b
2a
Note.
2b
3a
3b
4a
5a
5b
5c
6a
6b
7a
7b
7c
7e
7f
7g
7h
8
9a
9b
a
b
a
b
a
b
c
a
b
Organizations that may receive deductible contributions under section 170(c).
a
b
c
d
e
f
g
h
7d
8
9
10
11
12
13
14
Sponsoring organizations maintaining donor advised funds.
a
b
Section 501(c)(7) organizations.
a
b
10a
10b
Section 501(c)(12) organizations.
a
b
11a
11b
a
b
Section 4947(a)(1) non-exempt charitable trusts. 12a
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Note.
a
b
c
a
b
13a
13b
13c
14a
14b
e-file
If "No," provide an explanation in Schedule O
If "No," provide an explanation in Schedule O
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
Did the supporting
organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?
Form (2012)
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part V �����������������������������
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners? �������������������������������������������
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions)
~~~~~~~~~~
Did the organization have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a Form 990-T for this year?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
~~~~~~~~~~~~
~~~~~~~~~
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions?
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization notify the donor of the value of the goods or services provided?
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
~~~~~~~~~~~~~~~
����������������������������������������������������
If "Yes," indicate the number of Forms 8282 filed during the year
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
~~~~~~~~~~~~~~~~
~~~~~~~
~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
~
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
~~~~~~~~~~~~~~~
~~~~~~
Enter:
Gross income from members or shareholders
Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year ������
Is the organization licensed to issue qualified health plans in more than one state?
See the instructions for additional information the organization must report on Schedule O.
~~~~~~~~~~~~~~~~~~~~~
Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans
Enter the amount of reserves on hand
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive any payments for indoor tanning services during the tax year?
If "Yes," has it filed a Form 720 to report these payments?
~~~~~~~~~~~~~~~~
����������
5Part V Statements Regarding Other IRS Filings and Tax Compliance
990
J
Respiratory Health Association 36-2222687
140
X
58X
X
X
XX
X
XX
X
XX
X
8
23200612-10-12
Yes No
1a
1b
1
2
3
4
5
6
7
8
9
a
b
2
3
4
5
6
7a
7b
8a
8b
9
a
b
a
b
Yes No
10
11
a
b
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
a
b
12a
b
c
13
14
15
a
b
16a
b
17
18
19
20
For each "Yes" response to lines 2 through 7b below, and for a "No" responseto line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
If "Yes," provide the names and addresses in Schedule O(This Section B requests information about policies not required by the Internal Revenue Code.)
If "No," go to line 13
If "Yes," describein Schedule O how this was done
(explain in Schedule O)
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
Form (2012)
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VI �����������������������������
Enter the number of voting members of the governing body at the end of the tax year
Enter the number of voting members included in line 1a, above, who are independent
~~~~~~
~~~~~~
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
Did the organization have members or stockholders?
~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body?
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The governing body?
Each committee with authority to act on behalf of the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address? �����������������
Did the organization have local chapters, branches, or affiliates?
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
Describe in Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization regularly and consistently monitor and enforce compliance with the policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements? ������������������������������������
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
Own website Another's website Upon request Other
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: |
6Part VI Governance, Management, and Disclosure
Section A. Governing Body and Management
Section B. Policies
Section C. Disclosure
990
J
Respiratory Health Association 36-2222687
X
32
32
X
XXXX
X
X
XX
X
X
X
XX
XXX
XX
X
IL
X
Joel J. Africk - (312)243-20001440 West Washington Boulevard, Chicago, IL 60607
9
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Key
empl
oyee
Hig
hest
com
pens
ated
empl
oyee
Form
er
(do not check more than onebox, unless person is both anofficer and a director/trustee)
232007 12-10-12
current
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
current
current
former
former directors or trustees
(A) (B) (C) (D) (E) (F)
Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received reportablecompensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VII�����������������������������
¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.Enter -0- in columns (D), (E), and (F) if no compensation was paid.
¥ List all of the organization's key employees, if any. See instructions for definition of "key employee."¥
.
¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.
¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization,more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
PositionName and Title Average hours per
week (list any
hours forrelated
organizationsbelowline)
Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
Form (2012)
7Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
990
Respiratory Health Association 36-2222687
(1) Bradley D. Murlick 0.30Chair X X 0. 0. 0.(2) Cynthia Gronkiewicz, RN, MS, AP 0.30Chair-Elect X X 0. 0. 0.(3) David B. Yelin, Esq. 0.30Vice Chair X X 0. 0. 0.(4) H. Ari Jaffe, MD 0.30Secretary X X 0. 0. 0.(5) Steven L. Victor 0.30Treasurer X X 0. 0. 0.(6) Barry Levenstam, Esq. 0.30Past Board Chair X X 0. 0. 0.(7) Bapu P. Arekapudi, M.D. 0.30Board Member X 0. 0. 0.(8) Darryl M. Bradford 0.30Board Member X 0. 0. 0.(9) Joan D. Boomsma, M.D., MBA 0.30Board Member X 0. 0. 0.(10) Andrew Carolus 0.30Board Member X 0. 0. 0.(11) Cathy Catrambone, Ph.D., R.N. 0.30Board Member X 0. 0. 0.(12) Manuel P.A. Claudio, M.D. 0.30Board Member X 0. 0. 0.(13) Robert Cohen, M.D. 0.30Board Member X 0. 0. 0.(14) John M. Coruthers 0.30Board Member X 0. 0. 0.(15) Paul F. Detjen, M.D. 0.30Board Member X 0. 0. 0.(16) Donna Frownfelter, P.T., M.A. 0.30Board Member X 0. 0. 0.(17) Willard A. Fry, M.D. 0.30Board Member X 0. 0. 0.
10
Form
er
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Hig
hest
com
pens
ated
empl
oyee
Key
empl
oyee
(do not check more than onebox, unless person is both anofficer and a director/trustee)
23200812-10-12
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B) (C)(A) (D) (E) (F)
1b
c
d
Sub-total
Total from continuation sheets to Part VII, Section A
Total (add lines 1b and 1c)
2
Yes No
3
4
5
former
3
4
5
Section B. Independent Contractors
1
(A) (B) (C)
2
(continued)
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such person
Page Form 990 (2012)
PositionAverage hours per
week(list any
hours forrelated
organizationsbelowline)
Name and title Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
~~~~~~~~ |
���������������������� |
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization |
Did the organization list any officer, director, or trustee, key employee, or highest compensated employee on
line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? ~~~~~~~~~~~~~
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? ������������������������
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
Name and business address Description of services Compensation
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization |
Form (2012)
8Part VII
990
Respiratory Health Association 36-2222687
(18) Douglas A. Graham, Esq. 0.30Board Member X 0. 0. 0.(19) Cynthia Gronkiewicz, RN, MS 0.30Board Member X 0. 0. 0.(20) Diana P. Hackbarth, Ph.D., R.N. 0.30Board Member X 0. 0. 0.(21) Thomas A. Hensing, M.D. 0.30Board Member X 0. 0. 0.(22) Eva Hernandez, M.S.N. 0.30Board Member X 0. 0. 0.(23) Ravi Kalhan, M.D., M.S. 0.30Board Member X 0. 0. 0.(24) Jennifer Levin 0.30Board Member X 0. 0. 0.(25) Anthony M. Marinelli, M.D. 0.30Board Member X 0. 0. 0.(26) Paul Mastrapa 0.30Board Member X 0. 0. 0.
0. 0. 0.259,256. 0. 12,783.259,256. 0. 12,783.
1
X
X
X
NONE
0See Part VII, Section A Continuation sheets
11
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Key
empl
oyee
Hig
hest
com
pens
ated
em
ploy
ee
Form
er
23220107-25-12
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(A) (B) (C) (D) (E) (F)
(continued)Form 990
Name and title Average hours
per week
(list anyhours forrelated
organizationsbelowline)
Position (check all that apply)
Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
Total to Part VII, Section A, line 1c �������������������������
Part VII
Respiratory Health Association 36-2222687
(27) Jamar McNeil 0.30Board Member X 0. 0. 0.(28) Christopher O'Hara 0.30Board Member X 0. 0. 0.(29) Thomas Pluss 0.30Board Member X 0. 0. 0.(30) Laura Rogers, M.D. 0.30Board Member X 0. 0. 0.(31) William B. Van de Graaff, M.D 0.30Board Member X 0. 0. 0.(32) Janet Williams 0.30Board Member X 0. 0. 0.(33) Joel J. Africk 40.00President & CEO X 259,256. 0. 12,783.
259,256. 12,783.
12
Noncash contributions included in lines 1a-1f: $
23200912-10-12
Total revenue.
(A) (B) (C) (D)
1 a
b
c
d
e
f
g
h
1
1
1
1
1
1
a
b
c
d
e
f
Co
ntr
ibu
tio
ns
, G
ifts
, G
ran
tsa
nd
Oth
er
Sim
ila
r A
mo
un
ts
Total.
a
b
c
d
e
f
g
2
Pro
gra
m S
erv
ice
Re
ven
ue
Total.
3
4
5
6 a
b
c
d
a
b
c
d
7
a
b
c
8
a
b
9 a
b
c
a
b
10 a
b
c
a
b
11 a
b
c
d
e Total.
Oth
er
Re
ven
ue
12
Revenue excludedfrom tax undersections 512,513, or 514
All other contributions, gifts, grants, and
similar amounts not included above
See instructions.
Form (2012)
Page Form 990 (2012)
Check if Schedule O contains a response to any question in this Part VIII ���������������������������
Total revenue Related orexempt function
revenue
Unrelatedbusinessrevenue
Federated campaigns
Membership dues
~~~~~~
~~~~~~~~
Fundraising events
Related organizations
~~~~~~~~
~~~~~~
Government grants (contributions)
~~
Add lines 1a-1f ����������������� |
Business Code
All other program service revenue ~~~~~
Add lines 2a-2f ����������������� |
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
~~~~~~~~~~~~~~~~~ |
|
Royalties ����������������������� |
(i) Real (ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)
~~~~~~~
~~~
~~
�������������� |
Gross amount from sales of
assets other than inventory
(i) Securities (ii) Other
Less: cost or other basis
and sales expenses
Gain or (loss)
~~~
~~~~~~~
Net gain or (loss) ������������������� |
Gross income from fundraising events (not
including $ of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~~
Less: direct expenses~~~~~~~~~~
Net income or (loss) from fundraising events ����� |
Gross income from gaming activities. See
Part IV, line 19 ~~~~~~~~~~~~~
Less: direct expenses
Net income or (loss) from gaming activities
~~~~~~~~~
������ |
Gross sales of inventory, less returns
and allowances ~~~~~~~~~~~~~
Less: cost of goods sold
Net income or (loss) from sales of inventory
~~~~~~~~
������ |
Miscellaneous Revenue Business Code
All other revenue ~~~~~~~~~~~~~
Add lines 11a-11d ~~~~~~~~~~~~~~~ |
|�������������
9Part VIII Statement of Revenue
990
Respiratory Health Association 36-2222687
1,475,991.
899,268.
470,211.
2,845,470.
Lung Health 900099 210,315. 210,315.Tobacco Control 900099 133,246. 133,246.Environmental Health 900099 10,899. 10,899.Research 900099 3,291. 3,291.
357,751.
43,279. 43,279.
213,357.116,383.96,974.
96,974. 96,974.
1,713,109.
1,620,825.92,284.
92,284. 92,284.
1,475,991.
293,971.502,591.
-208,620. -208,620.
10,537.0.
10,537. 10,537.
3,237,675. 368,288. 0. 23,917.
13
Check here if following SOP 98-2 (ASC 958-720)
232010 12-10-12
Total functional expenses.
Joint costs.
(A) (B) (C) (D)
1
2
3
4
5
6
7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24
a
b
c
d
e
25
26
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Grants and other assistance to governments and
organizations in the United States. See Part IV, line 21
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Professional fundraising services. See Part IV, line 17
(If line 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch O.)
Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.)
Add lines 1 through 24e
Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part IX ��������������������������
Total expenses Program serviceexpenses
Management andgeneral expenses
Fundraisingexpenses
Grants and other assistance to individuals in
the United States. See Part IV, line 22 ~~~
Grants and other assistance to governments,
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16 ~
Benefits paid to or for members ~~~~~~~
Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~
~~~
Other salaries and wages ~~~~~~~~~~
Other employee benefits ~~~~~~~~~~
Payroll taxes ~~~~~~~~~~~~~~~~
Fees for services (non-employees):
Management
Legal
Accounting
Lobbying
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Investment management fees
Other.
~~~~~~~~
Advertising and promotion
Office expenses
Information technology
Royalties
~~~~~~~~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Occupancy ~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~Travel
Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings ~~
Interest
Payments to affiliates
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
Depreciation, depletion, and amortization
Insurance
~~
~~~~~~~~~~~~~~~~~
~~
All other expenses
|
Form (2012)
Do not include amounts reported on lines 6b,7b, 8b, 9b, and 10b of Part VIII.
10Part IX Statement of Functional Expenses
990
Respiratory Health Association 36-2222687
85,655. 85,655.
272,039. 272,039.
1,758,615. 1,241,208. 163,624. 353,783.
55,871. 40,497. 5,172. 10,202.135,487. 93,038. 14,767. 27,682.175,629. 129,343. 15,628. 30,658.
88,375. 72,595. 4,636. 11,144.21,000. 21,000.
185,738. 148,824. 10,845. 26,069.4,740. 4,740.
130,246. 101,405. 5,907. 22,934.
153,713. 132,001. 3,762. 17,950.65,210. 59,791. 2,794. 2,625.
67,587. 54,444. 13,143.
27,073. 19,422. 1,929. 5,722.
Printing & Postage 54,045. 43,414. 881. 9,750.Dues & Subscriptions 5,053. 1,541. 3,274. 238.Miscellaneous 3,592. 3,077. 189. 326.
3,289,668. 2,524,034. 233,408. 532,226.
14
23201112-10-12
(A) (B)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
1
2
3
4
5
6
7
8
9
10c
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
a
b
10a
10b
As
se
ts
Total assets.
Lia
bil
itie
s
Total liabilities.
Organizations that follow SFAS 117 (ASC 958), check here and
complete lines 27 through 29, and lines 33 and 34.
27
28
29
Organizations that do not follow SFAS 117 (ASC 958), check here
and complete lines 30 through 34.
30
31
32
33
34
Ne
t A
ss
ets
or
Fu
nd
Ba
lan
ce
s
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part X ������������������������������
Beginning of year End of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from other disqualified persons (as defined under
section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing
employers and sponsoring organizations of section 501(c)(9) voluntary
employees' beneficiary organizations (see instr). Complete Part II of Sch L ~~
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
Less: accumulated depreciation
~~~
~~~~~~
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~
Add lines 1 through 15 (must equal line 34) ����������
Accounts payable and accrued expenses
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~
Secured mortgages and notes payable to unrelated third parties ~~~~~~
Unsecured notes and loans payable to unrelated third parties ~~~~~~~~
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X of
Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 17 through 25 ������������������
|
Unrestricted net assets
Temporarily restricted net assets
Permanently restricted net assets
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
|
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~
Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~
Total liabilities and net assets/fund balances ����������������
Form (2012)
11Balance SheetPart X
990
Respiratory Health Association 36-2222687
487,384. 342,443.250,125. 189,505.40,880. 29,958.1,110. 81,648.
21,282. 15,388.
2,125,468.1,684,657. 427,074. 440,811.
1,836,110. 1,678,176.
1,431,175. 1,461,393.4,495,140. 4,239,322.985,050. 798,475.
948,112. 695,058.
1,933,162. 1,493,533.X
1,130,803. 1,284,396.
1,431,175. 1,461,393.
2,561,978. 2,745,789.4,495,140. 4,239,322.
15
23201212-10-12
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Yes No
1
2
3
a
b
c
2a
2b
2c
a
b
3a
3b
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part XI �����������������������������
Total revenue (must equal Part VIII, column (A), line 12)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other changes in net assets or fund balances (explain in Schedule O)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column (B))
~~~~~~~~~~~~~~~~~~~
�����������������������������������������������
Check if Schedule O contains a response to any question in this Part XII�����������������������������
Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits ����������������
Form (2012)
12Part XI Reconciliation of Net Assets
Part XII Financial Statements and Reporting
990
Respiratory Health Association 36-2222687
X
3,237,675.3,289,668.-51,993.
2,561,978.67,496.
168,308.
2,745,789.
X
X
X
X
X
X
X
16
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23202112-04-12
(iii)
(see instructions)
(iv) (i)
(v)
(i)
(vi)
(i)
(i) (ii) (vii)
(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.
Open to PublicInspection
Name of the organization Employer identification number
1
2
3
4
5
6
7
8
9
10
11
section 170(b)(1)(A)(i).
section 170(b)(1)(A)(ii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iv).
section 170(b)(1)(A)(v).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(vi).
section 509(a)(2).
section 509(a)(4).
section 509(a)(3).
a b c d
e
f
g
h
(i)
(ii)
(iii)
Yes No
11g(i)
11g(ii)
11g(iii)
Yes No Yes No Yes No
Total
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Schedule A (Form 990 or 990-EZ) 2012
Type of organization (described on lines 1-9 above or IRC section
)
Is the organizationin col. listed in yourgoverning document?
Did you notify theorganization in col.
of your support?
Is theorganization in col.
organized in theU.S.?
Name of supportedorganization
EIN Amount of monetarysupport
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
A church, convention of churches, or association of churches described in
A school described in (Attach Schedule E.)
A hospital or a cooperative hospital service organization described in
A medical research organization operated in conjunction with a hospital described in Enter the hospital's name,
city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
(Complete Part II.)
A federal, state, or local government or governmental unit described in
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
(Complete Part II.)
A community trust described in (Complete Part II.)
An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or
more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
Type I Type II Type III - Functionally integrated Type III - Non-functionally integrated
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
the governing body of the supported organization?
A family member of a person described in (i) above?
A 35% controlled entity of a person described in (i) or (ii) above?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~
Provide the following information about the supported organization(s).
LHA
SCHEDULE A
Part I Reason for Public Charity Status
Public Charity Status and Public Support 2012
Respiratory Health Association 36-2222687
X
17
Subtract line 5 from line 4.
23202212-04-12
Calendar year (or fiscal year beginning in)
Calendar year (or fiscal year beginning in) |
2
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
Total.
6 Public support.
(a) (b) (c) (d) (e) (f)
7
8
9
10
11
12
13
Total support.
12
First five years.
stop here
14
15
14
15
16
17
18
a
b
a
b
33 1/3% support test - 2012.
stop here.
33 1/3% support test - 2011.
stop here.
10% -facts-and-circumstances test - 2012.
stop here.
10% -facts-and-circumstances test - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
|
Add lines 7 through 10
Schedule A (Form 990 or 990-EZ) 2012 Page
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization
fails to qualify under the tests listed below, please complete Part III.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
Add lines 1 through 3 ~~~
The portion of total contributions
by each person (other than a
governmental unit or publicly
supported organization) included
on line 1 that exceeds 2% of the
amount shown on line 11,
column (f) ~~~~~~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 4 ~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~
Net income from unrelated business
activities, whether or not the
business is regularly carried on ~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.) ~~~~
Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and ��������������������������������������������� |
~~~~~~~~~~~~Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
Public support percentage from 2011 Schedule A, Part II, line 14
%
%~~~~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part IV how the organization
meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part IV how the
organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ��� |
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Respiratory Health Association 36-2222687
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
26,147,638.
2,957,041. 3,553,603. 9,214,781. 7,785,363. 2,636,850. 26,147,638.
298,398. 286,086. 289,975. 278,742. 256,636. 1,409,837.
27,557,475.
94.8894.94
X
18
(Subtract line 7c from line 6.)
Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
amount on line 13 for the year
(Add lines 9, 10c, 11, and 12.)
232023 12-04-12
Calendar year (or fiscal year beginning in) |
Calendar year (or fiscal year beginning in) |
Total support.
3
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
6
7
Total.
a
b
c
8 Public support
(a) (b) (c) (d) (e) (f)
9
10a
b
c11
12
13
14 First five years.
stop here
15
16
15
16
17
18
19
20
2012
2011
17
18
a
b
33 1/3% support tests - 2012.
stop here.
33 1/3% support tests - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975
Schedule A (Form 990 or 990-EZ) 2012 Page
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to
qualify under the tests listed below, please complete Part II.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose
Gross receipts from activities that
are not an unrelated trade or bus-
iness under section 513 ~~~~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
~~~ Add lines 1 through 5
Amounts included on lines 1, 2, and
3 received from disqualified persons
~~~~~~
Add lines 7a and 7b ~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 6 ~~~~~~~Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~
~~~~
Add lines 10a and 10b ~~~~~~Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part IV.) ~~~~
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and ���������������������������������������������������� |
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
Public support percentage from 2011 Schedule A, Part III, line 15
~~~~~~~~~~~~ %
%��������������������
Investment income percentage for (line 10c, column (f) divided by line 13, column (f))
Investment income percentage from Schedule A, Part III, line 17
~~~~~~~~ %
%~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~ |
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization~~~~ |
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions �������� |
Part III Support Schedule for Organizations Described in Section 509(a)(2)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
19
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23204101-07-13
(Form 990 or 990-EZ)For Organizations Exempt From Income Tax Under section 501(c) and section 527
Open to PublicInspection
Complete if the organization is described below. Attach to Form 990 or Form 990-EZ.
| See separate instructions.
If the organization answered "Yes," to Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
If the organization answered "Yes," to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
If the organization answered "Yes," to Form 990, Part IV, line 5 (Proxy Tax), or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Employer identification number
1
2
3
1
2
3
4
Yes No
a
b
Yes No
1
2
3
4
5
Form 1120-POL Yes No
(a) (b) (c) (d) (e)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule C (Form 990 or 990-EZ) 2012
¥ Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
¥ Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
¥ Section 527 organizations: Complete Part I-A only.
¥ Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
¥ Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
¥ Section 501(c)(4), (5), or (6) organizations: Complete Part III.Name of organization
Provide a description of the organization's direct and indirect political campaign activities in Part IV.
Political expenditures
Volunteer hours
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of any excise tax incurred by the organization under section 4955
Enter the amount of any excise tax incurred by organization managers under section 4955
If the organization incurred a section 4955 tax, did it file Form 4720 for this year?
~~~~~~~~~~~~~ $
~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~
Was a correction made?
If "Yes," describe in Part IV.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount directly expended by the filing organization for section 527 exempt function activities
Enter the amount of the filing organization's funds contributed to other organizations for section 527
exempt function activities
~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL,
line 17b
Did the filing organization file for this year?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization
made payments. For each organization listed, enter the amount paid from the filing organization's funds. Also enter the amount of political
contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a
political action committee (PAC). If additional space is needed, provide information in Part IV.
Name Address EIN Amount paid fromfiling organization's
funds. If none, enter -0-.
Amount of politicalcontributions received and
promptly and directlydelivered to a separatepolitical organization.
If none, enter -0-.
LHA
SCHEDULE C
Part I-A Complete if the organization is exempt under section 501(c) or is a section 527 organization.
Part I-B Complete if the organization is exempt under section 501(c)(3).
Part I-C Complete if the organization is exempt under section 501(c), except section 501(c)(3).
Political Campaign and Lobbying Activities2012
J J
J
JJ
J
J
J
Respiratory Health Association 36-2222687
20
23204201-07-13
If the amount on line 1e, column (a) or (b) is:
2
A
B
Limits on Lobbying Expenditures(The term "expenditures" means amounts paid or incurred.)
(a) (b)
1a
b
c
d
e
f
The lobbying nontaxable amount is:
g
h
i
j
Yes No
4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
(a) (b) (c) (d) (e)
2a
b
c
d
e
f
Schedule C (Form 990 or 990-EZ) 2012
Schedule C (Form 990 or 990-EZ) 2012 Page
Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN,
expenses, and share of excess lobbying expenditures).
Check if the filing organization checked box A and "limited control" provisions apply.
Filingorganization's
totals
Affiliated grouptotals
Total lobbying expenditures to influence public opinion (grass roots lobbying)
Total lobbying expenditures to influence a legislative body (direct lobbying)
~~~~~~~~~~
~~~~~~~~~~~
Total lobbying expenditures (add lines 1a and 1b)
Other exempt purpose expenditures
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total exempt purpose expenditures (add lines 1c and 1d)
Lobbying nontaxable amount. Enter the amount from the following table in both columns.
~~~~~~~~~~~~~~~~~~~~
Not over $500,000
Over $500,000 but not over $1,000,000
Over $1,000,000 but not over $1,500,000
Over $1,500,000 but not over $17,000,000
Over $17,000,000
20% of the amount on line 1e.
$100,000 plus 15% of the excess over $500,000.
$175,000 plus 10% of the excess over $1,000,000.
$225,000 plus 5% of the excess over $1,500,000.
$1,000,000.
Grassroots nontaxable amount (enter 25% of line 1f)
Subtract line 1g from line 1a. If zero or less, enter -0-
Subtract line 1f from line 1c. If zero or less, enter -0-
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~
If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720
reporting section 4911 tax for this year? ��������������������������������������
Calendar year (or fiscal year beginning in)
2009 2010 2011 2012 Total
Lobbying nontaxable amount
Lobbying ceiling amount
(150% of line 2a, column(e))
Total lobbying expenditures
Grassroots nontaxable amount
Grassroots ceiling amount
(150% of line 2d, column (e))
Grassroots lobbying expenditures
Part II-A Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
J
J
Respiratory Health Association 36-2222687
21
23204301-07-13
3
(a) (b)
Yes No Amount
1
a
b
c
d
e
f
g
h
i
j
a
b
c
d
2
Yes No
1
2
3
1
2
3
1
2
3
4
5
(do not include amounts of political
expenses for which the section 527(f) tax was paid).
1
2a
2b
2c
3
4
5
a
b
c
Schedule C (Form 990 or 990-EZ) 2012
For each "Yes," response to lines 1a through 1i below, provide in Part IV a detailed descriptionof the lobbying activity.
Schedule C (Form 990 or 990-EZ) 2012 Page
During the year, did the filing organization attempt to influence foreign, national, state or
local legislation, including any attempt to influence public opinion on a legislative matter
or referendum, through the use of:
Volunteers?
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?
Media advertisements?
Mailings to members, legislators, or the public?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
Publications, or published or broadcast statements?
Grants to other organizations for lobbying purposes?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Direct contact with legislators, their staffs, government officials, or a legislative body?
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means?
Other activities?
~~~~~~
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total. Add lines 1c through 1i
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)?
If "Yes," enter the amount of any tax incurred under section 4912
If "Yes," enter the amount of any tax incurred by organization managers under section 4912
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
~~~~~~~~~~~~~~~~
~~~
������
Were substantially all (90% or more) dues received nondeductible by members?
Did the organization make only in-house lobbying expenditures of $2,000 or less?
Did the organization agree to carry over lobbying and political expenditures from the prior year?
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
���������
Dues, assessments and similar amounts from members
Section 162(e) nondeductible lobbying and political expenditures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Current year
Carryover from last year
Total
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess
does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political
expenditure next year?
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Taxable amount of lobbying and political expenditures (see instructions) ���������������������
Complete this part to provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; Part II-A (affiliated group list); Part II-A, line 2;
and Part II-B, line 1. Also, complete this part for any additional information.
Part II-B Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768(election under section 501(h)).
Part III-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Part III-B Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No," OR (b) Part III-A, line 3, isanswered "Yes."
Part IV Supplemental Information
Respiratory Health Association 36-2222687
XX
XX 10,396.
XX
X 78,944.X 42,037.
X131,377.
X
Part II-B, Line 1(i), Other Lobbying Activities:
I. Local
A. Support local government spending policies that encourage the addition
of pollution control devices on diesel engines used in local government
construction projects.
22
23204401-07-13
4
Schedule C (Form 990 or 990-EZ) 2012
(continued)Schedule C (Form 990 or 990-EZ) 2012 Page
Part IV Supplemental Information
Respiratory Health Association 36-2222687
B. Seek support for smoking cessation and tobacco prevention programs.
II. State
A. Defense of a statewide smoke-free law.
B. Support an increase in tobacco taxes.
C. Support legislation monitoring radon.
D. Support legislation that restricts the sale of flavored tobacco.
E. Support legislation to create a fund to retrofit diesel engines with
pollution control devices.
III. Federal
A. Support more federal resources dedicated to lung disease.
B. Support development of a national COPD program.
C. Support the Lung Cancer Mortality Reduction Act.
D. Support the Family Asthma Act.
E. Support full funding of the Diesel Emissions Reduction Act.
23
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23205112-10-12
Held at the End of the Tax Year
(Form 990) | Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
| Attach to Form 990. | See separate instructions.Open to PublicInspection
Name of the organization Employer identification number
(a) (b)
1
2
3
4
5
6
Yes No
Yes No
1
2
3
4
5
6
7
8
9
a
b
c
d
2a
2b
2c
2d
Yes No
Yes No
1
2
a
b
(i)
(ii)
a
b
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2012
Complete if the
organization answered "Yes" to Form 990, Part IV, line 6.
Donor advised funds Funds and other accounts
Total number at end of year
Aggregate contributions to (during year)
Aggregate grants from (during year)
Aggregate value at end of year
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
~~~~~~~~~~~~~
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds
are the organization's property, subject to the organization's exclusive legal control?~~~~~~~~~~~~~~~~~~
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit? ��������������������������������������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of an historically important land area
Preservation of a certified historic structure
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
day of the tax year.
Total number of conservation easements
Total acreage restricted by conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
Number of states where property subject to conservation easement is located |
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year |
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year | $
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
LHA
Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Part II Conservation Easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
SCHEDULE D Supplemental Financial Statements 2012
Respiratory Health Association 36-2222687
24
23205212-10-12
3
4
5
a
b
c
d
e
Yes No
1
2
a
b
c
d
e
f
a
b
Yes No
1c
1d
1e
1f
Yes No
(a) (b) (c) (d) (e)
1
2
3
4
a
b
c
d
e
f
g
a
b
c
a
b
Yes No
(i)
(ii)
3a(i)
3a(ii)
3b
(a) (b) (c) (d)
1a
b
c
d
e
Total.
Schedule D (Form 990) 2012
(continued)
(Column (d) must equal Form 990, Part X, column (B), line 10(c).)
Two years back Three years back Four years back
Schedule D (Form 990) 2012 Page
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items
(check all that apply):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange programs
Other
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets
to be sold to raise funds rather than to be maintained as part of the organization's collection? ������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 9, orreported an amount on Form 990, Part X, line 21.
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
If "Yes," explain the arrangement in Part XIII and complete the following table:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amount
Beginning balance
Additions during the year
Distributions during the year
Ending balance
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization include an amount on Form 990, Part X, line 21?
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII
~~~~~~~~~~~~~~~~~~~~~~~~~
�������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
Current year Prior year
Beginning of year balance
Contributions
Net investment earnings, gains, and losses
Grants or scholarships
~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment
Permanent endowment
Temporarily restricted endowment
The percentages in lines 2a, 2b, and 2c should equal 100%.
| %
| %
| %
Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
unrelated organizations
related organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIII the intended uses of the organization's endowment funds.
~~~~~~~~~~~~~~~~~~~~~~
See Form 990, Part X, line 10.
Description of property Cost or otherbasis (investment)
Cost or otherbasis (other)
Accumulateddepreciation
Book value
Land
Buildings
Leasehold improvements
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Equipment
Other
~~~~~~~~~~~~~~~~~
��������������������
Add lines 1a through 1e. |������������
2Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
Part IV Escrow and Custodial Arrangements.
Part V Endowment Funds.
Part VI Land, Buildings, and Equipment.
Respiratory Health Association 36-2222687
230,155. 230,155.437,495. 437,495. 0.777,154. 629,924. 147,230.586,661. 573,207. 13,454.94,003. 44,031. 49,972.
440,811.
25
(including name of security)
23205312-10-12
Total.
Total.
(a) (b) (c)
(a) (b) (c)
(a) (b)
Total.
(a) (b) 1.
Total.
2.
Schedule D (Form 990) 2012
(Column (b) must equal Form 990, Part X, col. (B) line 15.)
(Column (b) must equal Form 990, Part X, col. (B) line 25.)
Description of security or category
(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Schedule D (Form 990) 2012 Page
See Form 990, Part X, line 12.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
Financial derivatives
Closely-held equity interests
Other
~~~~~~~~~~~~~~~
~~~~~~~~~~~
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Description of investment typeSee Form 990, Part X, line 13.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
See Form 990, Part X, line 15.
Description Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
���������������������������� |
See Form 990, Part X, line 25.
Description of liability Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Federal income taxes
����� |
FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's
liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ������
3Part VII Investments - Other Securities.
Part VIII Investments - Program Related.
Part IX Other Assets.
Part X Other Liabilities.
Respiratory Health Association 36-2222687
Beneficial Interest in Irrevocable Trust 1,461,393.
1,461,393.
X
26
23205412-10-12
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d 2e
32e 1
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d
2e 1
2e
3
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
Schedule D (Form 990) 2012
(This must equal Form 990, Part I, line 12.)
(This must equal Form 990, Part I, line 18.)
Schedule D (Form 990) 2012 Page
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
~~~~~~~~~~~~~~~~~~~
Net unrealized gains on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part VIII, line 12, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total revenue. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
�����������������
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through
Subtract line from line
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part IX, line 25, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total expenses. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
����������������
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part
X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
4Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
Part XIII Supplemental Information
Respiratory Health Association 36-2222687
3,589,862.
67,496.
284,691.352,187.
3,237,675.
0.3,237,675.
3,406,051.
116,383.116,383.
3,289,668.
0.3,289,668.
Part X, Line 2: The Association is exempt from federal income taxes
under Section 501(c)(3) of the Internal Revenue Code and applicable state
law. Accordingly, no provision for such taxes has been recognized in these
financial statements.
Accounting standards on accounting for uncertainty in income taxes
addresses the determination of whether tax benefits claimed or expected to
be claimed on a tax return should be recorded in the financial statements.
27
23205512-10-12
5
Schedule D (Form 990) 2012
(continued)Schedule D (Form 990) 2012 Page Part XIII Supplemental Information
Respiratory Health Association 36-2222687
Under this guidance, the Association may recognize the tax benefit from an
uncertain tax position only if it is more likely than not that the tax
position will be sustained on examination by taxing authorities, based on
the technical merits of the position. Examples of tax positions include
the tax-exempt status of the Association and various positions related to
the potential sources of unrelated business income tax. The tax benefits
recognized in the financial statements from any such position are measured
based on the largest benefit that has a greater than 50 percent likelihood
of being realized upon ultimate settlement. The Association has reviewed
the tax positions for the open tax years (current and prior three tax
years) and has concluded that no provision for income tax is required in
the financial statements. There were no unrecognized tax benefits
identified or recorded as liabilities during the period covered by these
financial statements.
Forms 990 filed by the Association are subject to examiniation by the
Internal Revenue Service up to three years from the extended due date of
each return. Forms 990 filed by the Association are generally no longer
subject to examination for the years 2008 and prior.
Part XI, Line 2d - Other Adjustments:
Rental real estate expenses 116,383.
Increase in value of beneficial interest in irrevocable
trust 30,218.
Adjustment to pension liability 138,090.
Total to Schedule D, Part XI, Line 2d 284,691.
Part XII, Line 2d - Other Adjustments:
28
23205512-10-12
5
Schedule D (Form 990) 2012
(continued)Schedule D (Form 990) 2012 Page Part XIII Supplemental Information
Respiratory Health Association 36-2222687
Rental real estate expenses 116,383.
29
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Didfundraiser
have custodyor control of
contributions?
23208101-07-13
Schedule G (Form 990 or 990-EZ) 2012
(Form 990 or 990-EZ)
Open To PublicInspection
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.Employer identification number
1
a
b
c
d
a
b
e
f
g
2
Yes No
(i) (ii)
(iii) (iv)
(v)
(i)
(vi)
Yes No
Total
3
Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Name of the organization
Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are notrequired to complete this part.
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
Mail solicitations
Internet and email solicitations
Phone solicitations
In-person solicitations
Solicitation of non-government grants
Solicitation of government grants
Special fundraising events
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or
key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
Name and address of individualor entity (fundraiser)
ActivityGross receipts
from activity
Amount paidto (or retained by)
fundraiserlisted in col.
Amount paidto (or retained by)
organization
�������������������������������������� |
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registrationor licensing.
LHA
SCHEDULE G
Fundraising Activities. Part I
Supplemental Information RegardingFundraising or Gaming Activities 2012
Respiratory Health Association 36-2222687
30
232082 01-07-13
2
(d)
(a)
(c)
(a) (b) (c)
1
2
3
4
5
6
7
8
9
10
11
(a) (b)
(c) (d)
(a) (c)
1
2
3
4
5
6
7
8
Yes Yes Yes
No No No
9
10
a
b
Yes No
a
b
Yes No
Schedule G (Form 990 or 990-EZ) 2012
Pull tabs/instantbingo/progressive bingo
Schedule G (Form 990 or 990-EZ) 2012 Page Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000
of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
Total events
(add col. through
col. )
Re
ven
ue
Event #1 Event #2 Other events
(event type) (event type) (total number)
Gross receipts
Less: Contributions
~~~~~~~~~~~~~~
~~~~~~~~~~~
Gross income (line 1 minus line 2)
Dir
ec
t E
xpe
nse
s
����
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs ~~~~~~~~~~~~
Food and beverages
Entertainment
~~~~~~~~~~
~~~~~~~~~~~~~~
Other direct expenses ~~~~~~~~~~
Direct expense summary. Add lines 4 through 9 in column (d)
Net income summary. Combine line 3, column (d), and line 10
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
������������������������� |Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than
$15,000 on Form 990-EZ, line 6a.
Re
ven
ue Bingo Other gaming
Total gaming (addcol. through col. )
Dir
ec
t E
xpe
nse
s
Gross revenue ��������������
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs
Other direct expenses
~~~~~~~~~~~~
����������
% % %
Volunteer labor ~~~~~~~~~~~~~
Direct expense summary. Add lines 2 through 5 in column (d)
Net gaming income summary. Combine line 1, column d, and line 7
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
��������������������� |
Enter the state(s) in which the organization operates gaming activities:
Is the organization licensed to operate gaming activities in each of these states?
If "No," explain:
~~~~~~~~~~~~~~~~~~~~
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
If "Yes," explain:
~~~~~~~~~
Part II Fundraising Events.
Part III Gaming.
Respiratory Health Association 36-2222687
Hustle UpThe Hancock
SkylinePlunge 4
1,194,427. 182,028. 393,507. 1,769,962.
966,242. 167,928. 341,821. 1,475,991.
228,185. 14,100. 51,686. 293,971.
224,057. 132,755. 145,779. 502,591.502,591.
-208,620.
31
232083 01-07-13
3
11
12
13
14
15
Yes No
Yes No
a
b
13a
13b
Yes Noa
b
c
16
17
a
b
Yes No
Supplemental Information.
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012 Page
Does the organization operate gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed
to administer charitable gaming?
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the percentage of gaming activity operated in:
The organization's facility
An outside facility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ %
%~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address |
Does the organization have a contract with a third party from whom the organization receives gaming revenue?
If "Yes," enter the amount of gaming revenue received by the organization |
~~~~~~
$ and the amount
of gaming revenue retained by the third party | $ .
If "Yes," enter name and address of the third party:
Name |
Address |
Gaming manager information:
Name |
Gaming manager compensation |
Description of services provided |
$
Director/officer Employee Independent contractor
Mandatory distributions:
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year | $
Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III,
lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Part IV
Respiratory Health Association 36-2222687
32
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
23210112-18-12
Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States
SCHEDULE I(Form 990)
Complete if the organization answered "Yes" to Form 990, Part IV, line 21 or 22.
| Attach to Form 990.
Open to PublicInspection
Employer identification number
General Information on Grants and AssistancePart I
1
2
Yes No
Part II Grants and Other Assistance to Governments and Organizations in the United States.
(f) 1 (a) (b) (c) (d) (e) (g) (h)
2
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (2012)
Name of the organization
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and the selection
criteria used to award the grants or assistance? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Complete if the organization answered "Yes" to Form 990, Part IV, line 21, for any
recipient that received more than $5,000. Part II can be duplicated if additional space is needed.Method of
valuation (book,FMV, appraisal,
other)
Name and address of organizationor government
EIN IRC sectionif applicable
Amount ofcash grant
Amount ofnon-cash
assistance
Description ofnon-cash assistance
Purpose of grantor assistance
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table
Enter total number of other organizations listed in the line 1 table
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
�������������������������������������������������� |
LHA
2012
Respiratory Health Association 36-2222687
X
To fund research forFoundation of American Thoracic Illinois basedSociety - 25 Broadway, 18th Floor investigators in Chronic- NEW YORK, NY 10004 06-5148706 501(c)(3) 25,000. 0. Obstructive Pulmonary
The Chest Foundation To help reduce tobacco3300 Dundee Road use in the ChicagolandNORTHBROOK, IL 60062 32-3286520 501(c)(3) 5,000. 0. area
2.0.
See Part IV for Column (h) descriptions 33
232102 12-18-12
2Part III Grants and Other Assistance to Individuals in the United States.
(e) (a) (b) (c) (d) (f)
Part IV Supplemental Information.
Schedule I (Form 990) (2012)
Schedule I (Form 990) (2012) Page Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
Method of valuation(book, FMV, appraisal, other)
Type of grant or assistance Number ofrecipients
Amount ofcash grant
Amount of non-cash assistance
Description of non-cash assistance
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Respiratory Health Association 36-2222687
Schedule I, Part I, Line 2: Schedule I, Part I, Line 2:
Research grant applications are reviewed by a committee consisting of
various health professionals and the association. Ongoing monitoring and
final results are managed by the appropriate designee on the committee.
Part II, line 1, Column (h):
Name of Organization or Government:
Foundation of American Thoracic Society
(h) Purpose of Grant or Assistance: To fund research for Illinois based 34
23229105-01-12
2
Schedule I (Form 990)
Schedule I (Form 990) Page
Part IV Supplemental Information
Respiratory Health Association 36-2222687
investigators in Chronic Obstructive Pulmonary Disease (COPD)
35
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23211112-10-12
For certain Officers, Directors, Trustees, Key Employees, and HighestCompensated Employees
Complete if the organization answered "Yes" to Form 990,Part IV, line 23. Open to Public
InspectionAttach to Form 990. See separate instructions.Employer identification number
Yes No
1a
b
1b
2
2
3
4
a
b
c
4a
4b
4c
Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9.
5
5a
5b
6a
6b
7
8
9
a
b
6
a
b
7
8
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2012
|
| |Name of the organization
Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990,
Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Travel for companions
Housing allowance or residence for personal use
Payments for business use of personal residence
Tax indemnification and gross-up payments
Discretionary spending account
Health or social club dues or initiation fees
Personal services (e.g., maid, chauffeur, chef)
If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or
reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain~~~~~~~~~~~
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors,
trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ~~~~~~~~~~~~~~~~~~~~~
Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's
CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to
establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Independent compensation consultant
Form 990 of other organizations
Written employment contract
Compensation survey or study
Approval by the board or compensation committee
During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing
organization or a related organization:
Receive a severance payment or change-of-control payment?
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
Participate in, or receive payment from, an equity-based compensation arrangement?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the revenues of:
The organization?
Any related organization?
If "Yes" to line 5a or 5b, describe in Part III.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the net earnings of:
The organization?
Any related organization?
If "Yes" to line 6a or 6b, describe in Part III.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed payments
not described in lines 5 and 6? If "Yes," describe in Part III
Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the
initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in
Regulations section 53.4958-6(c)? ���������������������������������������������
LHA
SCHEDULE J(Form 990)
Part I Questions Regarding Compensation
Compensation Information
2012
Respiratory Health Association 36-2222687
XX X
X
XXX
XX
XX
X
X
36
23211212-12-12
2
Part II Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Note.
(B) (C) (D) (E) (F)
(i) (ii) (iii) (A)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
Schedule J (Form 990) 2012
Schedule J (Form 990) 2012 Page
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii).Do not list any individuals that are not listed on Form 990, Part VII.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
Breakdown of W-2 and/or 1099-MISC compensation Retirement andother deferredcompensation
Nontaxablebenefits
Total of columns(B)(i)-(D)
Compensationreported as deferred
in prior Form 990Basecompensation
Bonus &incentive
compensation
Otherreportable
compensation
Name and Title
Respiratory Health Association 36-2222687
(1) Joel J. Africk 251,613. 0. 7,643. 0. 12,783. 272,039. 0.President & CEO 0. 0. 0. 0. 0. 0. 0.
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Part III Supplemental Information
Schedule J (Form 990) 2012
Schedule J (Form 990) 2012 Page
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for anyadditional information.
Respiratory Health Association 36-2222687
Part I, Line 3: Compensation committee approves the CEO salary and
conducts performance reviews.
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OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23221101-04-13
(Form 990 or 990-EZ) Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.
| Attach to Form 990 or 990-EZ.Open to PublicInspection
Employer identification number
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization
LHA
SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2012
Respiratory Health Association 36-2222687
Form 990, Part III, Line 4b, Program Service Accomplishments:
Through partnerships with the city and county, as well as with private
businesses and other local health departments and hospitals,
Respiratory Health Association provides "Courage to Quit" smoking
cessation classes and "Intro to Tobacco-Free Living" workshops for
adults, as well as the "Operation Storefront" curriculum that
introduces teens to the tactics of tobacco-industry marketing toward
their age group, and encourages them to make the choice to stay
tobacco-free. In addition, Respiratory Health Association partners with
health departments and other community stakeholders to promote
smoke-free environments, including smoke-free housing.
These programmatic efforts are complemented by several policy
initiatives to increase smoke free environments (including parks) and
to resist efforts to create exemptions in the Illinois Clean Indoor Air
Law, which we helped pass in 2007.
Form 990, Part III, Line 4c, Program Service Accomplishments:
lawmakers were asked to support funds to clean up diesel vehicle
fleets, requirements that clean construction vehicles be used on
federally funded projects, and strategies to address global warming and
clean energy.
Form 990, Part III, Line 4d, Other Program Services:
Research: Advance the understanding and treatment of lung diseases by
supporting scientifically meritorious research.
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Employer identification number
Schedule O (Form 990 or 990-EZ) (2012)
Schedule O (Form 990 or 990-EZ) (2012) Page
Name of the organizationRespiratory Health Association 36-2222687
Research on a wide range of lung disease issues is considered,
including asthma, lung cancer, COPD, interstitial lung disease
(including pulmonary fibrosis) and women's lung health.
Respiratory Health Association aims to fund the most promising research
and strives to foster greater collaboration among researchers and among
organizations that support lung disease research. Through the
development of partnerships with other research organizations,
Respiratory Health Association is able to maximize research awards and
make every dollar raised go farther.
Research funded by Respiratory Health Association helps scientists
diagnose lung disease earlier, discover causes and find cures. The goal
is to help improve the quality of life for those living with lung
disease. Recently funded projects include efforts at University of
Chicago, University of Illinois at Chicago, Rush University Medical
Center and Northwestern University.
Expenses $ 64,043. including grants of $ 30,000. Revenue $ 3,388.
Form 990, Part VI, Section B, line 11: The CEO and Director of Finance and
Grant Administration reviewed Form 990 before providing to the Board of
Directors of the organization. The Board reviewed and approved Form 990
before filing.
Form 990, Part VI, Section B, Line 12c: All members of the Board of
Directors are required to complete a conflict of interest statement each
year identifying any interests that could give rise to conflicts. These
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23221201-04-13
2
Employer identification number
Schedule O (Form 990 or 990-EZ) (2012)
Schedule O (Form 990 or 990-EZ) (2012) Page
Name of the organizationRespiratory Health Association 36-2222687
forms are reviewed by the CEO and lists of potential conflicts are prepared
and used to monitor their involvement with decisions throughout the year.
Should a conflict of interest arise, the appropriate member of the Board of
Directors would be excluded from voting on the related or transaction.
Form 990, Part VI, Section B, Line 15a: The Board has established a CEO
performance review and compensation committee consisting of six officers of
the Board. The committee meets at least once annually to review the CEO's
performance and make any adjustments to CEO compensation. The committee
reviews and considers salary survey results and data regarding compensation
of top management officials at similarly sized non-profit organizations in
metropolitan Chicago. The committee also reviews and considers progress
toward individual and organizational goals, and the financial strength of
the organization. Periodically, the committee has engaged a compensation
consultant to undertake an independent review of the CEO's compensation and
to make recommendations regarding compensation adjustments.
Form 990, Part VI, Section C, Line 19: The Association's financial
statements are contained in the annual report and are available to the
public on the Association's website or upon request. The Association's
governing documents and conflict of interest policy are made available to
the public on request.
Form 990, Part XI, line 9, Changes in Net Assets:
Increase (Decrease) in value of beneficial interest in
irrevocable trust 30,218.
Adjustment to pension liability 138,090.
Total to Form 990, Part XI, Line 9 168,308.
41
Department of the TreasuryInternal Revenue Service
File by thedue date forfiling yourreturn. Seeinstructions.
22384101-21-13
| File a separate application for each return.
Automatic 3-Month Extension, complete only Part I
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1
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3a
b
c
3a
3b
3c
$
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$
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Caution.
For Privacy Act and Paperwork Reduction Act Notice, see instructions. 8868
www.irs.gov/efile e-file for Charities & Nonprofits.
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of timeto file income tax returns.
Form
(Rev. January 2013) OMB No. 1545-1709
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you have already been granted an automatic 3-month extension on a previously filed Form 8868.
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required to file Form 990-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension
of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain
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calendar year or
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If the tax year entered in line 1 is for less than 12 months, check reason: Initial return Final return
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If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
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estimated tax payments made. Include any prior year overpayment allowed as a credit.
Subtract line 3b from line 3a. Include your payment with this form, if required,
by using EFTPS (Electronic Federal Tax Payment System). See instructions.
If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions.
LHA Form (Rev. 1-2013)
Do not complete Part II unless (e-file)
Part I Automatic 3-Month Extension of Time. Only submit original (no copies needed).
8868 Application for Extension of Time To File anExempt Organization Return
X
Respiratory Health Association 36-2222687
1440 West Washington Boulevard
Chicago, IL 60607
0 1
Joel J. Africk1440 West Washington Boulevard - Chicago, IL 60607
(312)243-2000
February 15, 2014
X JUL 1, 2012 JUN 30, 2013
0.
0.
0.
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